{"hospital_name":"Lawrence Rehabilitation Center","standard_charge_information":[{"description":"Stelara      Inj 45mg/0.5","code_information":[{"code":"CP17744631831064480","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894006003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24487,"maximum":30609,"gross_charge":30609,"discounted_cash":30609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30609},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24487},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24487}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Stelara      Inj 45mg/0.5","code_information":[{"code":"CP17744631831063467","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894006002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24487,"maximum":30609,"gross_charge":30609,"discounted_cash":30609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30609},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24487},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24487}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Stelara      Inj 90mg/ml","code_information":[{"code":"CP17744631831068140","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894006103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24487,"maximum":30609,"gross_charge":30609,"discounted_cash":30609,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30609},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24487},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24487}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Kesimpta     Inj 20/.4ml","code_information":[{"code":"CP17744631830187990","type":"CDM"},{"code":"250","type":"RC"},{"code":"78100","type":"CPT","modifier":"768"}],"standard_charges":[{"setting":"outpatient","modifier_code":["768"],"minimum":20190,"maximum":25237,"gross_charge":25237,"discounted_cash":25237,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25237},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20190},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20190}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Skyrizi      Inj 150mg/ml","code_information":[{"code":"CP17744631831033413","type":"CDM"},{"code":"250","type":"RC"},{"code":"74105","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19070,"maximum":23838,"gross_charge":23838,"discounted_cash":23838,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23838},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19070},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19070}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Skyrizi Pen  Inj 150mg/ml","code_information":[{"code":"CP17744631831037473","type":"CDM"},{"code":"250","type":"RC"},{"code":"74210","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19070,"maximum":23838,"gross_charge":23838,"discounted_cash":23838,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23838},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19070},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19070}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Skyrizi      Inj 150dose","code_information":[{"code":"CP17744631831039439","type":"CDM"},{"code":"250","type":"RC"},{"code":"74204","type":"CPT","modifier":"202"}],"standard_charges":[{"setting":"outpatient","modifier_code":["202"],"minimum":15788,"maximum":19735,"gross_charge":19735,"discounted_cash":19735,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19735},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15788},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15788}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Lanreotide   Inj 120/.5ml","code_information":[{"code":"CP17744631830216381","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097087067","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14315,"maximum":17894,"gross_charge":17894,"discounted_cash":17894,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17894},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14315},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14315}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tremfya      Inj 100mg/ml","code_information":[{"code":"CP17744631831174369","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894064001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12236,"maximum":15295,"gross_charge":15295,"discounted_cash":15295,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15295},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12236},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12236}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lupron Depot Inj 45mg","code_information":[{"code":"CP17744631830389302","type":"CDM"},{"code":"250","type":"RC"},{"code":"74347","type":"CPT","modifier":"303"}],"standard_charges":[{"setting":"outpatient","modifier_code":["303"],"minimum":10818,"maximum":13522,"gross_charge":13522,"discounted_cash":13522,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13522},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10818},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10818}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Simponi      Inj 50/0.5ml","code_information":[{"code":"CP17744631831025163","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894007002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10662,"maximum":13327,"gross_charge":13327,"discounted_cash":13327,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13327},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10662},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10662}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Reblozyl     Inj 75mg","code_information":[{"code":"CP17744631830888480","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572077501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10069,"maximum":12586,"gross_charge":12586,"discounted_cash":12586,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12586},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10069},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10069}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Neulasta     Inj 6mg/0.6m","code_information":[{"code":"CP17744631830558515","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8558,"maximum":10697,"gross_charge":10697,"discounted_cash":10697,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10697},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8558},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8558}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Neulasta     Kit 6mg/0.6m","code_information":[{"code":"CP17744631830550206","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8558,"maximum":10697,"gross_charge":10697,"discounted_cash":10697,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10697},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8558},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8558}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Skyrizi      Inj 360/2.4","code_information":[{"code":"CP17744631831036788","type":"CDM"},{"code":"250","type":"RC"},{"code":"74107","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":7946,"maximum":9933,"gross_charge":9933,"discounted_cash":9933,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9933},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7946},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7946}]}],"drug_information":{"unit":360,"type":"EA"}},{"description":"Uzedy        Inj 100mg","code_information":[{"code":"CP17744631831217287","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759052010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7805,"maximum":9756,"gross_charge":9756,"discounted_cash":9756,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9756},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7805},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7805}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Uzedy        Inj 125mg","code_information":[{"code":"CP17744631831217494","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759063010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7805,"maximum":9756,"gross_charge":9756,"discounted_cash":9756,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9756},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7805},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7805}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Uzedy        Inj 150mg","code_information":[{"code":"CP17744631831211249","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759074010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7805,"maximum":9756,"gross_charge":9756,"discounted_cash":9756,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9756},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7805},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7805}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Uzedy        Inj 75mg","code_information":[{"code":"CP17744631831214303","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759041010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7805,"maximum":9756,"gross_charge":9756,"discounted_cash":9756,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9756},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7805},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7805}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Uzedy        Inj 50mg","code_information":[{"code":"CP17744631831213293","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759030510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7804,"maximum":9755,"gross_charge":9755,"discounted_cash":9755,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9755},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7804},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7804}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Avonex Pen   Kit 30mcg","code_information":[{"code":"CP17744631828804905","type":"CDM"},{"code":"250","type":"RC"},{"code":"59627033304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7256,"maximum":9070,"gross_charge":9070,"discounted_cash":9070,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9070},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7256},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7256}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Avonex Prefl Kit 30mcg","code_information":[{"code":"CP17744631828801516","type":"CDM"},{"code":"250","type":"RC"},{"code":"59627022205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7256,"maximum":9070,"gross_charge":9070,"discounted_cash":9070,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9070},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7256},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7256}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Cosentyx Pen Inj 150mg/ml","code_information":[{"code":"CP17744631829426911","type":"CDM"},{"code":"250","type":"RC"},{"code":"78063","type":"CPT","modifier":"968"}],"standard_charges":[{"setting":"outpatient","modifier_code":["968"],"minimum":6532,"maximum":8165,"gross_charge":8165,"discounted_cash":8165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8165},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6532}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Taltz        Inj 80mg/ml","code_information":[{"code":"CP17744631831099927","type":"CDM"},{"code":"250","type":"RC"},{"code":"21445","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":6100,"maximum":7625,"gross_charge":7625,"discounted_cash":7625,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7625},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6100}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Taltz        Inj 80mg/ml","code_information":[{"code":"CP17744631831098908","type":"CDM"},{"code":"250","type":"RC"},{"code":"27724","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":6100,"maximum":7625,"gross_charge":7625,"discounted_cash":7625,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7625},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6100}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Taltz *Not Avail","code_information":[{"code":"CP17744631831108513","type":"CDM"},{"code":"250","type":"RC"},{"code":"27724","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":6100,"maximum":7625,"gross_charge":7625,"discounted_cash":7625,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7625},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6100}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Udenyca      Inj 6mg/.6ml","code_information":[{"code":"CP17744631831203864","type":"CDM"},{"code":"250","type":"RC"},{"code":"70114010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5678,"maximum":7098,"gross_charge":7098,"discounted_cash":7098,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7098},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5678},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5678}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Humira Pen   Kit Cd/uc/hs","code_information":[{"code":"CP17744631830083649","type":"CDM"},{"code":"250","type":"RC"},{"code":"74012","type":"CPT","modifier":"403"}],"standard_charges":[{"setting":"outpatient","modifier_code":["403"],"minimum":5538,"maximum":6923,"gross_charge":6923,"discounted_cash":6923,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6923},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5538},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5538}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humira Pen   Inj 80/0.8ml","code_information":[{"code":"CP17744631830083167","type":"CDM"},{"code":"250","type":"RC"},{"code":"74012","type":"CPT","modifier":"402"}],"standard_charges":[{"setting":"outpatient","modifier_code":["402"],"minimum":5538,"maximum":6923,"gross_charge":6923,"discounted_cash":6923,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6923},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5538},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5538}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Sandostatin  Kit Lar 30mg","code_information":[{"code":"CP17744631830992551","type":"CDM"},{"code":"250","type":"RC"},{"code":"78082","type":"CPT","modifier":"581"}],"standard_charges":[{"setting":"outpatient","modifier_code":["581"],"minimum":5530,"maximum":6913,"gross_charge":6913,"discounted_cash":6913,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6913},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5530},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5530}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lupron Depot Inj 22.5mg","code_information":[{"code":"CP17744631830383272","type":"CDM"},{"code":"250","type":"RC"},{"code":"74334","type":"CPT","modifier":"603"}],"standard_charges":[{"setting":"outpatient","modifier_code":["603"],"minimum":5409,"maximum":6761,"gross_charge":6761,"discounted_cash":6761,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6761},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5409},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5409}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Ziextenzo    Inj 6/0.6ml","code_information":[{"code":"CP17744631831393352","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314086601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5338,"maximum":6673,"gross_charge":6673,"discounted_cash":6673,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6673},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5338},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5338}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Cimzia       Kit 200mg","code_information":[{"code":"CP17744631829232380","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474070062","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5039,"maximum":6299,"gross_charge":6299,"discounted_cash":6299,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6299},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5039},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5039}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cimzia       Kit Starter","code_information":[{"code":"CP17744631829237405","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474071081","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5039,"maximum":6299,"gross_charge":6299,"discounted_cash":6299,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6299},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5039},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5039}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cimzia Prefl Kit 200mg/ml","code_information":[{"code":"CP17744631829232514","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474071079","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5039,"maximum":6299,"gross_charge":6299,"discounted_cash":6299,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6299},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5039},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5039}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cimzia Start Kit 200mg/ml","code_information":[{"code":"CP17744631829236597","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474071081","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5039,"maximum":6299,"gross_charge":6299,"discounted_cash":6299,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6299},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5039},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5039}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cimzia-200mg-kit","code_information":[{"code":"CP17744631829235266","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474070062","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5039,"maximum":6299,"gross_charge":6299,"discounted_cash":6299,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6299},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5039},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5039}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fasenra      Inj 30mg/ml","code_information":[{"code":"CP17744631829849543","type":"CDM"},{"code":"250","type":"RC"},{"code":"31017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4818,"maximum":6022,"gross_charge":6022,"discounted_cash":6022,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6022},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4818},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4818}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Fasenra Pen  Inj 30mg/ml","code_information":[{"code":"CP17744631829841634","type":"CDM"},{"code":"250","type":"RC"},{"code":"31018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4818,"maximum":6022,"gross_charge":6022,"discounted_cash":6022,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6022},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4818},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4818}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Nplate       Inj 500mcg","code_information":[{"code":"CP17744631830644352","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4625,"maximum":5781,"gross_charge":5781,"discounted_cash":5781,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5781},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4625},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4625}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lupron Depot Inj 11.25mg","code_information":[{"code":"CP17744631830383042","type":"CDM"},{"code":"250","type":"RC"},{"code":"74366","type":"CPT","modifier":"303"}],"standard_charges":[{"setting":"outpatient","modifier_code":["303"],"minimum":4539,"maximum":5674,"gross_charge":5674,"discounted_cash":5674,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5674},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4539},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4539}]}],"drug_information":{"unit":1125,"type":"ME"}},{"description":"Sandostatin  Kit Lar 20mg","code_information":[{"code":"CP17744631830997171","type":"CDM"},{"code":"250","type":"RC"},{"code":"78081","type":"CPT","modifier":"881"}],"standard_charges":[{"setting":"outpatient","modifier_code":["881"],"minimum":3693,"maximum":4616,"gross_charge":4616,"discounted_cash":4616,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4616},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3693},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3693}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Invega Hafye Inj 1560mg","code_information":[{"code":"CP17744631830150777","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458061201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3509,"maximum":4386,"gross_charge":4386,"discounted_cash":4386,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4386},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3509},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3509}]}],"drug_information":{"unit":1560,"type":"ME"}},{"description":"Cosentyx Uno Inj 300/2ml","code_information":[{"code":"CP17744631829426831","type":"CDM"},{"code":"250","type":"RC"},{"code":"78107","type":"CPT","modifier":"68"}],"standard_charges":[{"setting":"outpatient","modifier_code":["68"],"minimum":3397,"maximum":4246,"gross_charge":4246,"discounted_cash":4246,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4246},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3397},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3397}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Invega Trinz 546mg 1.85ml Dose","code_information":[{"code":"CP17744631830150562","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458060801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3342,"maximum":4177,"gross_charge":4177,"discounted_cash":4177,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4177},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3342},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3342}]}],"drug_information":{"unit":546,"type":"ME"}},{"description":"Invega Trinz Inj 546mg","code_information":[{"code":"CP17744631830156073","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458060801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3342,"maximum":4177,"gross_charge":4177,"discounted_cash":4177,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4177},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3342},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3342}]}],"drug_information":{"unit":546,"type":"ME"}},{"description":"Invega Trinz 819mg 2.63ml Dose","code_information":[{"code":"CP17744631830153050","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458060901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3335,"maximum":4169,"gross_charge":4169,"discounted_cash":4169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4169},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3335},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3335}]}],"drug_information":{"unit":819,"type":"ME"}},{"description":"Invega Trinz Inj 819mg","code_information":[{"code":"CP17744631830150625","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458060901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3335,"maximum":4169,"gross_charge":4169,"discounted_cash":4169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4169},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3335},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3335}]}],"drug_information":{"unit":819,"type":"ME"}},{"description":"Invega Trinz 410mg 1.32ml Dose","code_information":[{"code":"CP17744631830150285","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458060701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3322,"maximum":4153,"gross_charge":4153,"discounted_cash":4153,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4153},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3322},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3322}]}],"drug_information":{"unit":410,"type":"ME"}},{"description":"Invega Trinz Inj 410mg","code_information":[{"code":"CP17744631830152863","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458060701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3322,"maximum":4153,"gross_charge":4153,"discounted_cash":4153,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4153},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3322},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3322}]}],"drug_information":{"unit":410,"type":"ME"}},{"description":"Invega Trinz Inj 273mg","code_information":[{"code":"CP17744631830154107","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458060601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3322,"maximum":4153,"gross_charge":4153,"discounted_cash":4153,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4153},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3322},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3322}]}],"drug_information":{"unit":273,"type":"ME"}},{"description":"Cosentyx     Inj 300dose","code_information":[{"code":"CP17744631829428951","type":"CDM"},{"code":"250","type":"RC"},{"code":"78063","type":"CPT","modifier":"998"}],"standard_charges":[{"setting":"outpatient","modifier_code":["998"],"minimum":3266,"maximum":4083,"gross_charge":4083,"discounted_cash":4083,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4083},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3266},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3266}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Cosentyx 150 Mg/ml","code_information":[{"code":"CP17744631829421133","type":"CDM"},{"code":"250","type":"RC"},{"code":"78063","type":"CPT","modifier":"998"}],"standard_charges":[{"setting":"outpatient","modifier_code":["998"],"minimum":3266,"maximum":4083,"gross_charge":4083,"discounted_cash":4083,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4083},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3266},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3266}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cosentyx Pen Inj 300dose","code_information":[{"code":"CP17744631829428603","type":"CDM"},{"code":"250","type":"RC"},{"code":"78063","type":"CPT","modifier":"941"}],"standard_charges":[{"setting":"outpatient","modifier_code":["941"],"minimum":3266,"maximum":4083,"gross_charge":4083,"discounted_cash":4083,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4083},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3266},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3266}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Nucala       Inj 100mg/ml","code_information":[{"code":"CP17744631830646761","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3193,"maximum":3991,"gross_charge":3991,"discounted_cash":3991,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3991},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3193}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Aranesp      Inj 150mcg","code_information":[{"code":"CP17744631828731448","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aranesp      Inj 200mcg","code_information":[{"code":"CP17744631828739419","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aranesp      Inj 300mcg","code_information":[{"code":"CP17744631828730319","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Aranesp      Inj 500mcg","code_information":[{"code":"CP17744631828735884","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aranesp 300mcg/0.6ml Inj","code_information":[{"code":"CP17744631828738669","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Aranesp Pfs 150mcg 0.3ml Dose","code_information":[{"code":"CP17744631828731272","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aranesp Pfs 200mcg 0.4ml Dose","code_information":[{"code":"CP17744631828731938","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aranesp Pfs 300mcg 0.6ml Dose","code_information":[{"code":"CP17744631828734028","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3096,"maximum":3870,"gross_charge":3870,"discounted_cash":3870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3096},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3096}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Orencia      Inj 50/0.4ml","code_information":[{"code":"CP17744631830690613","type":"CDM"},{"code":"250","type":"RC"},{"code":"32814","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":3035,"maximum":3794,"gross_charge":3794,"discounted_cash":3794,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3794},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3035},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3035}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Nucala       Inj 100mg","code_information":[{"code":"CP17744631830645290","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2940,"maximum":3675,"gross_charge":3675,"discounted_cash":3675,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3675},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2940},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2940}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Humira Pen   Inj Cd/uc/hs","code_information":[{"code":"CP17744631830089083","type":"CDM"},{"code":"250","type":"RC"},{"code":"74433","type":"CPT","modifier":"906"}],"standard_charges":[{"setting":"outpatient","modifier_code":["906"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humira       Inj 20/0.2ml","code_information":[{"code":"CP17744631830081145","type":"CDM"},{"code":"250","type":"RC"},{"code":"74061","type":"CPT","modifier":"602"}],"standard_charges":[{"setting":"outpatient","modifier_code":["602"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Humira       Inj 40/0.4ml","code_information":[{"code":"CP17744631830084434","type":"CDM"},{"code":"250","type":"RC"},{"code":"74024","type":"CPT","modifier":"302"}],"standard_charges":[{"setting":"outpatient","modifier_code":["302"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Humira       Kit 40mg/0.8","code_information":[{"code":"CP17744631830085935","type":"CDM"},{"code":"250","type":"RC"},{"code":"74379","type":"CPT","modifier":"902"}],"standard_charges":[{"setting":"outpatient","modifier_code":["902"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Humira 40mg/0.8ml Pen Inj","code_information":[{"code":"CP17744631830081626","type":"CDM"},{"code":"250","type":"RC"},{"code":"74433","type":"CPT","modifier":"902"}],"standard_charges":[{"setting":"outpatient","modifier_code":["902"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Humira Pen   Inj 40/0.4ml","code_information":[{"code":"CP17744631830088543","type":"CDM"},{"code":"250","type":"RC"},{"code":"74055","type":"CPT","modifier":"402"}],"standard_charges":[{"setting":"outpatient","modifier_code":["402"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Humira Pen   Inj 40mg/0.8","code_information":[{"code":"CP17744631830082834","type":"CDM"},{"code":"250","type":"RC"},{"code":"74433","type":"CPT","modifier":"902"}],"standard_charges":[{"setting":"outpatient","modifier_code":["902"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Humira Pen-40mg/0.4ml 1 Box=2","code_information":[{"code":"CP17744631830096699","type":"CDM"},{"code":"250","type":"RC"},{"code":"74055","type":"CPT","modifier":"402"}],"standard_charges":[{"setting":"outpatient","modifier_code":["402"],"minimum":2769,"maximum":3461,"gross_charge":3461,"discounted_cash":3461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2769},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2769}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Zymfentra    Inj 120mg/ml","code_information":[{"code":"CP17744631831411898","type":"CDM"},{"code":"250","type":"RC"},{"code":"72606002501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2674,"maximum":3343,"gross_charge":3343,"discounted_cash":3343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2674},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2674}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Abilify Main Inj 400mg","code_information":[{"code":"CP17744631828115795","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148007280","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2394,"maximum":2992,"gross_charge":2992,"discounted_cash":2992,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2992},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2394}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Abilify Maintenna Pfs 400mg","code_information":[{"code":"CP17744631828128624","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148007280","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2394,"maximum":2992,"gross_charge":2992,"discounted_cash":2992,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2992},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2394},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2394}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Abilify Main Inj 400mg","code_information":[{"code":"CP17744631828114213","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148001971","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2323,"maximum":2904,"gross_charge":2904,"discounted_cash":2904,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2904},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2323},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2323}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Perseris     Inj 120mg","code_information":[{"code":"CP17744631830753531","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496012001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2319,"maximum":2899,"gross_charge":2899,"discounted_cash":2899,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2899},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2319},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2319}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Nplate       Inj 250mcg","code_information":[{"code":"CP17744631830645249","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513022101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2313,"maximum":2891,"gross_charge":2891,"discounted_cash":2891,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2891},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2313},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2313}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Eligard      Inj 45mg","code_information":[{"code":"CP17744631829772453","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935045345","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2168,"maximum":2710,"gross_charge":2710,"discounted_cash":2710,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2710},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2168},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2168}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Leqvio       Sol","code_information":[{"code":"CP17744631830293142","type":"CDM"},{"code":"250","type":"RC"},{"code":"78100","type":"CPT","modifier":"60"}],"standard_charges":[{"setting":"outpatient","modifier_code":["60"],"minimum":1990,"maximum":2487,"gross_charge":2487,"discounted_cash":2487,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2487},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1990},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1990}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Invega Sust  Inj 156mg/ml","code_information":[{"code":"CP17744631830157298","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1950,"maximum":2437,"gross_charge":2437,"discounted_cash":2437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1950},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1950}]}],"drug_information":{"unit":156,"type":"ME"}},{"description":"Invega Sust Pfs 156/1ml Dose","code_information":[{"code":"CP17744631830158515","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1950,"maximum":2437,"gross_charge":2437,"discounted_cash":2437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1950},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1950}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Invega Sust  Inj 234/1.5","code_information":[{"code":"CP17744631830155394","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1950,"maximum":2437,"gross_charge":2437,"discounted_cash":2437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1950},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1950}]}],"drug_information":{"unit":234,"type":"EA"}},{"description":"Invega Sust Pfs 234/1.5ml Dose","code_information":[{"code":"CP17744631830153481","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1950,"maximum":2437,"gross_charge":2437,"discounted_cash":2437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1950},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1950}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Invega Sust  Inj 117/0.75","code_information":[{"code":"CP17744631830155997","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1950,"maximum":2437,"gross_charge":2437,"discounted_cash":2437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1950},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1950}]}],"drug_information":{"unit":117,"type":"EA"}},{"description":"Invega Sust 117mg/0.75ml Inj","code_information":[{"code":"CP17744631830152648","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1950,"maximum":2437,"gross_charge":2437,"discounted_cash":2437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1950},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1950}]}],"drug_information":{"unit":117,"type":"ME"}},{"description":"Invega Sustpfs 117/0.75ml Dose","code_information":[{"code":"CP17744631830150976","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1950,"maximum":2437,"gross_charge":2437,"discounted_cash":2437,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2437},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1950},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1950}]}],"drug_information":{"unit":75,"type":"ML"}},{"description":"Invega Sust  Inj 78/0.5ml","code_information":[{"code":"CP17744631830159002","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1949,"maximum":2436,"gross_charge":2436,"discounted_cash":2436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1949},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1949}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Invega Sust Pfs 78/0.5ml Dose","code_information":[{"code":"CP17744631830159386","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1949,"maximum":2436,"gross_charge":2436,"discounted_cash":2436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1949},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1949}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Invega Sust  Inj 39/0.25","code_information":[{"code":"CP17744631830154842","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1949,"maximum":2436,"gross_charge":2436,"discounted_cash":2436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1949},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1949}]}],"drug_information":{"unit":39,"type":"EA"}},{"description":"Invega Sust Pfs 39/0.25ml Dose","code_information":[{"code":"CP17744631830156327","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458056001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1949,"maximum":2436,"gross_charge":2436,"discounted_cash":2436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1949},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1949}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Lupron Depot 7.5mg Inj Kit","code_information":[{"code":"CP17744631830385064","type":"CDM"},{"code":"250","type":"RC"},{"code":"74364","type":"CPT","modifier":"203"}],"standard_charges":[{"setting":"outpatient","modifier_code":["203"],"minimum":1803,"maximum":2254,"gross_charge":2254,"discounted_cash":2254,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2254},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1803},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1803}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Abilify Main Inj 300mg","code_information":[{"code":"CP17744631828117615","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148004580","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1795,"maximum":2244,"gross_charge":2244,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2244},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1795},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1795}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Abilify Maintenna Pfs 300mg","code_information":[{"code":"CP17744631828122298","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148004580","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1795,"maximum":2244,"gross_charge":2244,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2244},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1795},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1795}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Abilify Pfs 300mg","code_information":[{"code":"CP17744631828125286","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148004580","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1795,"maximum":2244,"gross_charge":2244,"discounted_cash":2244,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2244},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1795},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1795}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Enbrel       Inj 50mg/ml","code_information":[{"code":"CP17744631829774882","type":"CDM"},{"code":"250","type":"RC"},{"code":"58406002104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1713,"maximum":2141,"gross_charge":2141,"discounted_cash":2141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1713},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1713}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Enbrel Mini  Inj 50mg/ml","code_information":[{"code":"CP17744631829777999","type":"CDM"},{"code":"250","type":"RC"},{"code":"58406004404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1713,"maximum":2141,"gross_charge":2141,"discounted_cash":2141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1713},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1713}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Enbrel Srclk Inj 50mg/ml","code_information":[{"code":"CP17744631829775984","type":"CDM"},{"code":"250","type":"RC"},{"code":"58406003204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1713,"maximum":2141,"gross_charge":2141,"discounted_cash":2141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1713},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1713}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Xgeva        Inj","code_information":[{"code":"CP17744631831388653","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1672,"maximum":2090,"gross_charge":2090,"discounted_cash":2090,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2090},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1672},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1672}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prolia       Inj 60mg/ml","code_information":[{"code":"CP17744631830844412","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1546,"maximum":1932,"gross_charge":1932,"discounted_cash":1932,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1932},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1546},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1546}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Prolia       Inj 60mg/ml","code_information":[{"code":"CP17744631830845229","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1546,"maximum":1932,"gross_charge":1932,"discounted_cash":1932,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1932},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1546},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1546}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Prolia       Sol 60mg/ml","code_information":[{"code":"CP17744631830841520","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513071001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1546,"maximum":1932,"gross_charge":1932,"discounted_cash":1932,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1932},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1546},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1546}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Tymlos       Inj","code_information":[{"code":"CP17744631831207732","type":"CDM"},{"code":"250","type":"RC"},{"code":"70539000102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1537,"maximum":1921,"gross_charge":1921,"discounted_cash":1921,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1921},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1537},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1537}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Forteo       Inj 600/2.4","code_information":[{"code":"CP17744631829999412","type":"CDM"},{"code":"250","type":"RC"},{"code":"28400","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1532,"maximum":1915,"gross_charge":1915,"discounted_cash":1915,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1915},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1532}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Forteo       Inj 620/2.48","code_information":[{"code":"CP17744631829990657","type":"CDM"},{"code":"250","type":"RC"},{"code":"28400","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1532,"maximum":1915,"gross_charge":1915,"discounted_cash":1915,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1915},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1532}]}],"drug_information":{"unit":620,"type":"EA"}},{"description":"Forteo       Sol 600/2.4","code_information":[{"code":"CP17744631829997921","type":"CDM"},{"code":"250","type":"RC"},{"code":"28400","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1532,"maximum":1915,"gross_charge":1915,"discounted_cash":1915,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1915},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1532}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Rebif        Inj 44/0.5","code_information":[{"code":"CP17744631830885514","type":"CDM"},{"code":"250","type":"RC"},{"code":"44087004403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1524,"maximum":1905,"gross_charge":1905,"discounted_cash":1905,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1905},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1524},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1524}]}],"drug_information":{"unit":44,"type":"EA"}},{"description":"Rebif Rebido Inj 44/0.5","code_information":[{"code":"CP17744631830882615","type":"CDM"},{"code":"250","type":"RC"},{"code":"44087334401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1524,"maximum":1905,"gross_charge":1905,"discounted_cash":1905,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1905},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1524},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1524}]}],"drug_information":{"unit":44,"type":"EA"}},{"description":"Abilify Asim Inj 960mg","code_information":[{"code":"CP17744631828110250","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148011480","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1496,"maximum":1870,"gross_charge":1870,"discounted_cash":1870,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1870},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1496},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1496}]}],"drug_information":{"unit":960,"type":"ME"}},{"description":"Dupixent     Inj 200/1.14","code_information":[{"code":"CP17744631829758631","type":"CDM"},{"code":"250","type":"RC"},{"code":"24591","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":1471,"maximum":1839,"gross_charge":1839,"discounted_cash":1839,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1839},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1471},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1471}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Vivitrol     Inj 380mg","code_information":[{"code":"CP17744631831305663","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757030001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1434,"maximum":1792,"gross_charge":1792,"discounted_cash":1792,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1792},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1434},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1434}]}],"drug_information":{"unit":380,"type":"ME"}},{"description":"Dalvance     Sol 500mg","code_information":[{"code":"CP17744631829471864","type":"CDM"},{"code":"250","type":"RC"},{"code":"57970010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1423,"maximum":1779,"gross_charge":1779,"discounted_cash":1779,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1779},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1423},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1423}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Room And Board","code_information":[{"code":"CP17744631657091744","type":"CDM"},{"code":"118","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":773,"maximum":1408,"gross_charge":1760,"discounted_cash":1760,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":807},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1408},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":773},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1408}]}]},{"description":"Gvoke Hypo 1 Inj 1mg/.2ml","code_information":[{"code":"CP17744631830067868","type":"CDM"},{"code":"250","type":"RC"},{"code":"72065012111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1341,"maximum":1676,"gross_charge":1676,"discounted_cash":1676,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1676},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1341}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Gvoke Hypo 1mg/0.2ml Kit=0.2ml","code_information":[{"code":"CP17744631830066648","type":"CDM"},{"code":"250","type":"RC"},{"code":"72065012111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1341,"maximum":1676,"gross_charge":1676,"discounted_cash":1676,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1676},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1341}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Gvoke Hypo 1mg/0.2ml Sub-q","code_information":[{"code":"CP17744631830068284","type":"CDM"},{"code":"250","type":"RC"},{"code":"72065012111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1341,"maximum":1676,"gross_charge":1676,"discounted_cash":1676,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1676},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1341}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Gvoke Hypo 2 Inj 1mg/.2ml","code_information":[{"code":"CP17744631830066559","type":"CDM"},{"code":"250","type":"RC"},{"code":"72065012112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1341,"maximum":1676,"gross_charge":1676,"discounted_cash":1676,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1676},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1341}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Gvoke Pfs    Inj","code_information":[{"code":"CP17744631830066107","type":"CDM"},{"code":"250","type":"RC"},{"code":"72065013111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1341,"maximum":1676,"gross_charge":1676,"discounted_cash":1676,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1676},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1341}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adalimu-adaz Inj 40/0.4ml","code_information":[{"code":"CP17744631828343513","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314032720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1282,"maximum":1603,"gross_charge":1603,"discounted_cash":1603,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1603},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1282},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1282}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Aranesp      Inj 100mcg","code_information":[{"code":"CP17744631828732314","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1238,"maximum":1548,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aranesp      Inj 200mcg","code_information":[{"code":"CP17744631828734503","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1238,"maximum":1548,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aranesp      Inj 60mcg","code_information":[{"code":"CP17744631828733920","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1238,"maximum":1548,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Aranesp 60mcg/0.3ml Injection","code_information":[{"code":"CP17744631828734748","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1238,"maximum":1548,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Aranesp Pfs 100mcg 0.5ml Dose","code_information":[{"code":"CP17744631828730454","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1238,"maximum":1548,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aranesp Pfs 60mcg 0.3ml Dose","code_information":[{"code":"CP17744631828733881","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1238,"maximum":1548,"gross_charge":1548,"discounted_cash":1548,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1548},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1238}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Orencia      Inj 125mg/ml","code_information":[{"code":"CP17744631830693913","type":"CDM"},{"code":"250","type":"RC"},{"code":"32188","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":1214,"maximum":1518,"gross_charge":1518,"discounted_cash":1518,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1214}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Orencia Clck Inj 125mg/ml","code_information":[{"code":"CP17744631830695264","type":"CDM"},{"code":"250","type":"RC"},{"code":"32188","type":"CPT","modifier":"51"}],"standard_charges":[{"setting":"outpatient","modifier_code":["51"],"minimum":1214,"maximum":1518,"gross_charge":1518,"discounted_cash":1518,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1518},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1214}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Keytruda     Inj 100mg/4m","code_information":[{"code":"CP17744631830194781","type":"CDM"},{"code":"250","type":"RC"},{"code":"63026","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":1203,"maximum":1504,"gross_charge":1504,"discounted_cash":1504,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1504},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1203},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1203}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Aristada     Inj 441mg/1.","code_information":[{"code":"CP17744631828750956","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757040103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1170,"maximum":1462,"gross_charge":1462,"discounted_cash":1462,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1462},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1170},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1170}]}],"drug_information":{"unit":441,"type":"ME"}},{"description":"Nplate       Inj 125mcg","code_information":[{"code":"CP17744631830649389","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513022301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1156,"maximum":1445,"gross_charge":1445,"discounted_cash":1445,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1445},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1156},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1156}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Eligard      Inj 22.5mg","code_information":[{"code":"CP17744631829773031","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935022710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1084,"maximum":1355,"gross_charge":1355,"discounted_cash":1355,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1355},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1084},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1084}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Eligard      Inj 22.5mg","code_information":[{"code":"CP17744631829771382","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935022305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1084,"maximum":1355,"gross_charge":1355,"discounted_cash":1355,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1355},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1084},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1084}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Gleostine    Cap 100mg","code_information":[{"code":"CP17744631830036845","type":"CDM"},{"code":"250","type":"RC"},{"code":"58181304205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1073,"maximum":1341,"gross_charge":1341,"discounted_cash":1341,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1341},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1073},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1073}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Risperdal    Inj 50mg","code_information":[{"code":"CP17744631830890920","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458030811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1063,"maximum":1329,"gross_charge":1329,"discounted_cash":1329,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1329},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1063},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1063}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Actemra      Inj 162/0.9","code_information":[{"code":"CP17744631828326796","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242013801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1044,"maximum":1305,"gross_charge":1305,"discounted_cash":1305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1305},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1044},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1044}]}],"drug_information":{"unit":162,"type":"EA"}},{"description":"Actemra      Inj Actpen","code_information":[{"code":"CP17744631828325600","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242014301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1044,"maximum":1305,"gross_charge":1305,"discounted_cash":1305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1305},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1044},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1044}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Botox 200unit Inj","code_information":[{"code":"CP17744631828942727","type":"CDM"},{"code":"250","type":"RC"},{"code":"23392","type":"CPT","modifier":"102"}],"standard_charges":[{"setting":"outpatient","modifier_code":["102"],"minimum":1042,"maximum":1302,"gross_charge":1302,"discounted_cash":1302,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1302},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1042},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1042}]}],"drug_information":{"unit":200,"type":"UN"}},{"description":"Xifaxan      Tab 550mg","code_information":[{"code":"CP17744631831387454","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649030303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1028,"maximum":1285,"gross_charge":1285,"discounted_cash":1285,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1285},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1028}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Benlysta     Inj 200mg/ml","code_information":[{"code":"CP17744631828858618","type":"CDM"},{"code":"250","type":"RC"},{"code":"49401008835","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1027,"maximum":1284,"gross_charge":1284,"discounted_cash":1284,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1284},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1027},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1027}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Risperidone  Inj 50mg Er","code_information":[{"code":"CP17744631830904874","type":"CDM"},{"code":"250","type":"RC"},{"code":"48014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1007,"maximum":1259,"gross_charge":1259,"discounted_cash":1259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1259},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1007},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1007}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Idhifa       Tab 100mg","code_information":[{"code":"CP17744631830133002","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572071030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":961,"maximum":1201,"gross_charge":1201,"discounted_cash":1201,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1201},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":961},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":961}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pomalyst     Cap 2mg","code_information":[{"code":"CP17744631830789234","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572050221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":954,"maximum":1193,"gross_charge":1193,"discounted_cash":1193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":954},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":954}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Evenity      Inj 105mg","code_information":[{"code":"CP17744631829825379","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":944,"maximum":1180,"gross_charge":1180,"discounted_cash":1180,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1180},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":944},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":944}]}],"drug_information":{"unit":105,"type":"ME"}},{"description":"Harvoni 90-400mg Tabs","code_information":[{"code":"CP17744631830070884","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958180101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":900,"maximum":1125,"gross_charge":1125,"discounted_cash":1125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":900},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":900}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Teriparatide Inj","code_information":[{"code":"CP17744631831118118","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781065289","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":864,"maximum":1080,"gross_charge":1080,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Teriparatide Inj 620/2.48","code_information":[{"code":"CP17744631831119163","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781065289","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":864,"maximum":1080,"gross_charge":1080,"discounted_cash":1080,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1080},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":864},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":864}]}],"drug_information":{"unit":620,"type":"EA"}},{"description":"Procrit      Inj 40000/ml","code_information":[{"code":"CP17744631830832309","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":855,"maximum":1069,"gross_charge":1069,"discounted_cash":1069,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1069},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":855},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":855}]}],"drug_information":{"unit":40000,"type":"EA"}},{"description":"Aristada     Inj 662mg/2","code_information":[{"code":"CP17744631828754176","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757040203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":844,"maximum":1055,"gross_charge":1055,"discounted_cash":1055,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1055},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":844},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":844}]}],"drug_information":{"unit":662,"type":"ME"}},{"description":"Aristada     Inj 882mg/3","code_information":[{"code":"CP17744631828759748","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757040303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":843,"maximum":1054,"gross_charge":1054,"discounted_cash":1054,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1054},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":843},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":843}]}],"drug_information":{"unit":882,"type":"ME"}},{"description":"Dupixent     Inj 300/2ml","code_information":[{"code":"CP17744631829757976","type":"CDM"},{"code":"250","type":"RC"},{"code":"24591","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":838,"maximum":1048,"gross_charge":1048,"discounted_cash":1048,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Dupixent     Inj 300/2ml","code_information":[{"code":"CP17744631829752742","type":"CDM"},{"code":"250","type":"RC"},{"code":"24591","type":"CPT","modifier":"502"}],"standard_charges":[{"setting":"outpatient","modifier_code":["502"],"minimum":838,"maximum":1048,"gross_charge":1048,"discounted_cash":1048,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1048},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Lagevrio     Cap 200mg","code_information":[{"code":"CP17744631830204035","type":"CDM"},{"code":"250","type":"RC"},{"code":"65055","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":838,"maximum":1047,"gross_charge":1047,"discounted_cash":1047,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1047},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":838},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":838}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Aristada     Inj 1064mg","code_information":[{"code":"CP17744631828755615","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757040403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":834,"maximum":1043,"gross_charge":1043,"discounted_cash":1043,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1043},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":834},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":834}]}],"drug_information":{"unit":1064,"type":"ME"}},{"description":"Ozempic      Inj 2mg/3ml","code_information":[{"code":"CP17744631830724305","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":822,"maximum":1028,"gross_charge":1028,"discounted_cash":1028,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":822}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ozempic (0.25 Mg Or 0.5mg)3ml","code_information":[{"code":"CP17744631830723641","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":822,"maximum":1028,"gross_charge":1028,"discounted_cash":1028,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":822}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ozempic (0.25mg/0.5mg)2mg/3ml","code_information":[{"code":"CP17744631830721522","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":822,"maximum":1028,"gross_charge":1028,"discounted_cash":1028,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":822}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ozempic 0.25/0.5 Dose(2mg/3ml)","code_information":[{"code":"CP17744631830728913","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":822,"maximum":1028,"gross_charge":1028,"discounted_cash":1028,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1028},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":822},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":822}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Risperdal    Inj 37.5mg","code_information":[{"code":"CP17744631830895252","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458030711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":798,"maximum":997,"gross_charge":997,"discounted_cash":997,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":997},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":798},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":798}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Ojjaara      Tab 200mg","code_information":[{"code":"CP17744631830665719","type":"CDM"},{"code":"250","type":"RC"},{"code":"81864010130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":791,"maximum":989,"gross_charge":989,"discounted_cash":989,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":989},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":791},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":791}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Trelstar Mix Inj 3.75mg","code_information":[{"code":"CP17744631831174995","type":"CDM"},{"code":"250","type":"RC"},{"code":"74676590201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":767,"maximum":959,"gross_charge":959,"discounted_cash":959,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":959},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":767},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":767}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Piqray 200mg Tab Dose","code_information":[{"code":"CP17744631830787342","type":"CDM"},{"code":"250","type":"RC"},{"code":"78070","type":"CPT","modifier":"184"}],"standard_charges":[{"setting":"outpatient","modifier_code":["184"],"minimum":734,"maximum":918,"gross_charge":918,"discounted_cash":918,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":918},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":734},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":734}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Epclusa      Tab 400-100","code_information":[{"code":"CP17744631829799658","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958220101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":712,"maximum":890,"gross_charge":890,"discounted_cash":890,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":712},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":712}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Epclusa Tab 200-50mg","code_information":[{"code":"CP17744631829799117","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958220301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":712,"maximum":890,"gross_charge":890,"discounted_cash":890,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":712},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":712}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Vosevi       Tab","code_information":[{"code":"CP17744631831302282","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958240101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":712,"maximum":890,"gross_charge":890,"discounted_cash":890,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":890},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":712},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":712}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omnitrope    Inj 10/1.5ml","code_information":[{"code":"CP17744631830689574","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":707,"maximum":884,"gross_charge":884,"discounted_cash":884,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":884},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":707},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":707}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Byetta       Inj 5mcg","code_information":[{"code":"CP17744631829042993","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":680,"maximum":850,"gross_charge":850,"discounted_cash":850,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":850},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":680}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Byetta 5 Mcg/0.02ml Pen 1.2ml","code_information":[{"code":"CP17744631829041084","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":680,"maximum":850,"gross_charge":850,"discounted_cash":850,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":850},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":680}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Byetta 5mcg/0.02ml Pen","code_information":[{"code":"CP17744631829041224","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":680,"maximum":850,"gross_charge":850,"discounted_cash":850,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":850},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":680},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":680}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zyprexa Relp Inj 300mg","code_information":[{"code":"CP17744631831415858","type":"CDM"},{"code":"250","type":"RC"},{"code":"27636","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":674,"maximum":842,"gross_charge":842,"discounted_cash":842,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":842},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":674},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":674}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Risperidone  Inj 37.5mg","code_information":[{"code":"CP17744631830907725","type":"CDM"},{"code":"250","type":"RC"},{"code":"48013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":662,"maximum":828,"gross_charge":828,"discounted_cash":828,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":828},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":662}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Ajovy        Inj 225/1.5","code_information":[{"code":"CP17744631828374972","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759020210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":634,"maximum":793,"gross_charge":793,"discounted_cash":793,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":793},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":634},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":634}]}],"drug_information":{"unit":225,"type":"EA"}},{"description":"Aimovig      Inj 140mg/ml","code_information":[{"code":"CP17744631828370685","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513084301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":626,"maximum":783,"gross_charge":783,"discounted_cash":783,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":626},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":626}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Aimovig      Inj 70mg/ml","code_information":[{"code":"CP17744631828371915","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513084101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":626,"maximum":783,"gross_charge":783,"discounted_cash":783,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":783},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":626},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":626}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Aranesp      Inj 100mcg","code_information":[{"code":"CP17744631828730961","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513000504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":619,"maximum":774,"gross_charge":774,"discounted_cash":774,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":619},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":619}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aranesp      Inj 40mcg","code_information":[{"code":"CP17744631828734292","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":619,"maximum":774,"gross_charge":774,"discounted_cash":774,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":619},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":619}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Aranesp 40mcg/0.4ml Inj","code_information":[{"code":"CP17744631828739488","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":619,"maximum":774,"gross_charge":774,"discounted_cash":774,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":619},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":619}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Aranesp Pfs 40mcg 0.4ml Dose","code_information":[{"code":"CP17744631828734854","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513002104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":619,"maximum":774,"gross_charge":774,"discounted_cash":774,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":774},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":619},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":619}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Emgality     Inj 120mg/ml","code_information":[{"code":"CP17744631829773634","type":"CDM"},{"code":"250","type":"RC"},{"code":"22377","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":611,"maximum":764,"gross_charge":764,"discounted_cash":764,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":764},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":611},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":611}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Emgality     Inj 120mg/ml","code_information":[{"code":"CP17744631829770978","type":"CDM"},{"code":"250","type":"RC"},{"code":"21436","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":611,"maximum":764,"gross_charge":764,"discounted_cash":764,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":764},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":611},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":611}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Emverm       Chw 100mg","code_information":[{"code":"CP17744631829771427","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":597,"maximum":746,"gross_charge":746,"discounted_cash":746,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":597},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":597}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Betaseron    Inj 0.3mg","code_information":[{"code":"CP17744631828871920","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419052435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":597,"maximum":746,"gross_charge":746,"discounted_cash":746,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":746},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":597},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":597}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Xiidra       Dro 5%","code_information":[{"code":"CP17744631831383743","type":"CDM"},{"code":"250","type":"RC"},{"code":"78091","type":"CPT","modifier":"112"}],"standard_charges":[{"setting":"outpatient","modifier_code":["112"],"minimum":593,"maximum":741,"gross_charge":741,"discounted_cash":741,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":741},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":593},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":593}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rasuvo       Inj 10mg","code_information":[{"code":"CP17744631830871396","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137051004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":581,"maximum":726,"gross_charge":726,"discounted_cash":726,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":726},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Veklury      Inj 100mg","code_information":[{"code":"CP17744631831258225","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":567,"maximum":709,"gross_charge":709,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Veklury 100mg/250ml","code_information":[{"code":"CP17744631831256355","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":567,"maximum":709,"gross_charge":709,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Veklury 200mg/250ml","code_information":[{"code":"CP17744631831259475","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958290102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":567,"maximum":709,"gross_charge":709,"discounted_cash":709,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":709},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":567},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":567}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Promacta     Tab 75mg","code_information":[{"code":"CP17744631830846422","type":"CDM"},{"code":"250","type":"RC"},{"code":"78068","type":"CPT","modifier":"715"}],"standard_charges":[{"setting":"outpatient","modifier_code":["715"],"minimum":566,"maximum":708,"gross_charge":708,"discounted_cash":708,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":566}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Promacta 75mg Tabs","code_information":[{"code":"CP17744631830841432","type":"CDM"},{"code":"250","type":"RC"},{"code":"78068","type":"CPT","modifier":"715"}],"standard_charges":[{"setting":"outpatient","modifier_code":["715"],"minimum":566,"maximum":708,"gross_charge":708,"discounted_cash":708,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":708},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":566},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":566}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Palynziq     Inj 20mg/ml","code_information":[{"code":"CP17744631830736009","type":"CDM"},{"code":"250","type":"RC"},{"code":"68135067340","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":558,"maximum":697,"gross_charge":697,"discounted_cash":697,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":697},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Wegovy       Inj 0.25mg","code_information":[{"code":"CP17744631831370844","type":"CDM"},{"code":"250","type":"RC"},{"code":"16945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":540,"maximum":675,"gross_charge":675,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Wegovy       Inj 0.5mg","code_information":[{"code":"CP17744631831375018","type":"CDM"},{"code":"250","type":"RC"},{"code":"16945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":540,"maximum":675,"gross_charge":675,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Wegovy       Inj 1mg","code_information":[{"code":"CP17744631831375892","type":"CDM"},{"code":"250","type":"RC"},{"code":"16945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":540,"maximum":675,"gross_charge":675,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Wegovy-1mg/0.5ml-soaj","code_information":[{"code":"CP17744631831372313","type":"CDM"},{"code":"250","type":"RC"},{"code":"16945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":540,"maximum":675,"gross_charge":675,"discounted_cash":675,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":675},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":540},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":540}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ozempic      Inj 2/1.5ml","code_information":[{"code":"CP17744631830724273","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":532,"maximum":665,"gross_charge":665,"discounted_cash":665,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Ozempic 0.25/0.5 Mg/dose","code_information":[{"code":"CP17744631830729023","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":532,"maximum":665,"gross_charge":665,"discounted_cash":665,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ozempic 0.25/0.5mg Dose","code_information":[{"code":"CP17744631830720816","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":532,"maximum":665,"gross_charge":665,"discounted_cash":665,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ozempic 0.25/0.5mg Dose","code_information":[{"code":"CP17744631830728784","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":532,"maximum":665,"gross_charge":665,"discounted_cash":665,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ozempic 0.25mg/0.5mg Dose","code_information":[{"code":"CP17744631830721512","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":532,"maximum":665,"gross_charge":665,"discounted_cash":665,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Risperdal    Inj 25mg","code_information":[{"code":"CP17744631830892614","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458030611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":532,"maximum":665,"gross_charge":665,"discounted_cash":665,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":665},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":532},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":532}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Neupogen     Inj 480/0.8","code_information":[{"code":"CP17744631830553984","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513020991","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":531,"maximum":664,"gross_charge":664,"discounted_cash":664,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":664},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531}]}],"drug_information":{"unit":480,"type":"EA"}},{"description":"Neupogen Pfs 480mcg/0.8ml Dose","code_information":[{"code":"CP17744631830557198","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513020991","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":531,"maximum":664,"gross_charge":664,"discounted_cash":664,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":664},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Neupogen     Inj 480/0.8","code_information":[{"code":"CP17744631830557372","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513020910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":531,"maximum":664,"gross_charge":664,"discounted_cash":664,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":664},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":531},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":531}]}],"drug_information":{"unit":480,"type":"EA"}},{"description":"Sancuso      Dis 3.1mg","code_information":[{"code":"CP17744631830991670","type":"CDM"},{"code":"250","type":"RC"},{"code":"42747072601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":530,"maximum":662,"gross_charge":662,"discounted_cash":662,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":662},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":530}]}],"drug_information":{"unit":31,"type":"ME"}},{"description":"Hypertet     Inj 250/ml","code_information":[{"code":"CP17744631830128749","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533063402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":525,"maximum":656,"gross_charge":656,"discounted_cash":656,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":656},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":525},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":525}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Botox 100 Units","code_information":[{"code":"CP17744631828947961","type":"CDM"},{"code":"250","type":"RC"},{"code":"23114","type":"CPT","modifier":"501"}],"standard_charges":[{"setting":"outpatient","modifier_code":["501"],"minimum":521,"maximum":651,"gross_charge":651,"discounted_cash":651,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":651},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Hadlima      Inj 40/0.8ml","code_information":[{"code":"CP17744631830067444","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206018301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":519,"maximum":649,"gross_charge":649,"discounted_cash":649,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":649},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Ibrance 100mg Caps","code_information":[{"code":"CP17744631830124855","type":"CDM"},{"code":"250","type":"RC"},{"code":"69018","type":"CPT","modifier":"821"}],"standard_charges":[{"setting":"outpatient","modifier_code":["821"],"minimum":515,"maximum":644,"gross_charge":644,"discounted_cash":644,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":644},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":515}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mresvia      Inj 50mcg","code_information":[{"code":"CP17744631830512668","type":"CDM"},{"code":"250","type":"RC"},{"code":"80777034596","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":510,"maximum":638,"gross_charge":638,"discounted_cash":638,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":638},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":510}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Emgality     Inj 100mg/ml","code_information":[{"code":"CP17744631829770573","type":"CDM"},{"code":"250","type":"RC"},{"code":"23115","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":510,"maximum":637,"gross_charge":637,"discounted_cash":637,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":637},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":510},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":510}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tudorza Pres Aer 400/act","code_information":[{"code":"CP17744631831208101","type":"CDM"},{"code":"250","type":"RC"},{"code":"72124000201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":498,"maximum":623,"gross_charge":623,"discounted_cash":623,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":623},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":498}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Yusimry      Inj 40/0.8ml","code_information":[{"code":"CP17744631831386903","type":"CDM"},{"code":"250","type":"RC"},{"code":"70114022002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":498,"maximum":622,"gross_charge":622,"discounted_cash":622,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":622},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":498},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":498}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Sprycel      Tab 100mg","code_information":[{"code":"CP17744631831068483","type":"CDM"},{"code":"250","type":"RC"},{"code":"30852","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":486,"maximum":608,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":486}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sprycel      Tab 80mg","code_information":[{"code":"CP17744631831062404","type":"CDM"},{"code":"250","type":"RC"},{"code":"30855","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":486,"maximum":608,"gross_charge":608,"discounted_cash":608,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":608},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":486}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Capvaxive    Inj 0.5ml","code_information":[{"code":"CP17744631829102472","type":"CDM"},{"code":"250","type":"RC"},{"code":"64347","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":483,"maximum":604,"gross_charge":604,"discounted_cash":604,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":604},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":483},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":483}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Omnipod 5 Dx Kit Int G7g6","code_information":[{"code":"CP17744631830686907","type":"CDM"},{"code":"250","type":"RC"},{"code":"8508300001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":478,"maximum":597,"gross_charge":597,"discounted_cash":597,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":597},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":478},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":478}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Duaklir      Aer 400/12","code_information":[{"code":"CP17744631829757886","type":"CDM"},{"code":"250","type":"RC"},{"code":"31009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":474,"maximum":592,"gross_charge":592,"discounted_cash":592,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":592},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":474},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":474}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Risperidone  Inj 25mg Er","code_information":[{"code":"CP17744631830902275","type":"CDM"},{"code":"250","type":"RC"},{"code":"48012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":467,"maximum":584,"gross_charge":584,"discounted_cash":584,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":584},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Rasuvo       Inj 12.5mg","code_information":[{"code":"CP17744631830877992","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137051504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":465,"maximum":581,"gross_charge":581,"discounted_cash":581,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":581},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":465},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":465}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Estring      Mis 7.5/24hr","code_information":[{"code":"CP17744631829829067","type":"CDM"},{"code":"250","type":"RC"},{"code":"13104","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":462,"maximum":577,"gross_charge":577,"discounted_cash":577,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":577},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":462},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":462}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zarxio       Inj 300/0.5","code_information":[{"code":"CP17744631831398471","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":448,"maximum":560,"gross_charge":560,"discounted_cash":560,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":448}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Zarxio       Inj 480/0.8","code_information":[{"code":"CP17744631831394886","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":448,"maximum":560,"gross_charge":560,"discounted_cash":560,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":448}]}],"drug_information":{"unit":480,"type":"EA"}},{"description":"Zarxio Pfs 300mcg/0.5ml Dose","code_information":[{"code":"CP17744631831397680","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314031801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":448,"maximum":560,"gross_charge":560,"discounted_cash":560,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":448}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Zarxio Pfs 480mcg/0.8ml Dose","code_information":[{"code":"CP17744631831398145","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":448,"maximum":560,"gross_charge":560,"discounted_cash":560,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":560},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":448},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":448}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Copaxone     Inj 40mg/ml","code_information":[{"code":"CP17744631829410632","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546032512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":446,"maximum":558,"gross_charge":558,"discounted_cash":558,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":558},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":446},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":446}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Mounjaro     Inj 12.5/0.5","code_information":[{"code":"CP17744631830515306","type":"CDM"},{"code":"250","type":"RC"},{"code":"21460","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":445,"maximum":556,"gross_charge":556,"discounted_cash":556,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Mounjaro     Inj 15mg/0.5","code_information":[{"code":"CP17744631830517276","type":"CDM"},{"code":"250","type":"RC"},{"code":"21457","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":445,"maximum":556,"gross_charge":556,"discounted_cash":556,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mounjaro     Inj 7.5/0.5","code_information":[{"code":"CP17744631830512536","type":"CDM"},{"code":"250","type":"RC"},{"code":"21484","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":445,"maximum":556,"gross_charge":556,"discounted_cash":556,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Mounjaro Pen 12.5 Mg/0.5mldose","code_information":[{"code":"CP17744631830510284","type":"CDM"},{"code":"250","type":"RC"},{"code":"21460","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":445,"maximum":556,"gross_charge":556,"discounted_cash":556,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Mounjaro Pen 15 Mg/0.5ml Dose","code_information":[{"code":"CP17744631830515282","type":"CDM"},{"code":"250","type":"RC"},{"code":"21457","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":445,"maximum":556,"gross_charge":556,"discounted_cash":556,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mounjaro Pen 7.5 Mg/0.5ml Dose","code_information":[{"code":"CP17744631830518294","type":"CDM"},{"code":"250","type":"RC"},{"code":"21484","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":445,"maximum":556,"gross_charge":556,"discounted_cash":556,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":556},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":445},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":445}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Zepbound     Inj 10/0.5ml","code_information":[{"code":"CP17744631831399490","type":"CDM"},{"code":"250","type":"RC"},{"code":"22471","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":434,"maximum":543,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Zepbound     Inj 12.5mg","code_information":[{"code":"CP17744631831396662","type":"CDM"},{"code":"250","type":"RC"},{"code":"22460","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":434,"maximum":543,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Zepbound     Inj 15/0.5ml","code_information":[{"code":"CP17744631831395301","type":"CDM"},{"code":"250","type":"RC"},{"code":"22457","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":434,"maximum":543,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Zepbound     Inj 2.5mg","code_information":[{"code":"CP17744631831395785","type":"CDM"},{"code":"250","type":"RC"},{"code":"22506","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":434,"maximum":543,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Zepbound     Inj 5/0.5ml","code_information":[{"code":"CP17744631831391284","type":"CDM"},{"code":"250","type":"RC"},{"code":"22495","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":434,"maximum":543,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Zepbound     Inj 7.5mg","code_information":[{"code":"CP17744631831396374","type":"CDM"},{"code":"250","type":"RC"},{"code":"22484","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":434,"maximum":543,"gross_charge":543,"discounted_cash":543,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":543},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":434},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":434}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Teflaro      Inj 600mg","code_information":[{"code":"CP17744631831107692","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Teflaro 200mg/250 Ns Qty1=3bag","code_information":[{"code":"CP17744631831107700","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Teflaro 300 Mg/250 Ml Ns","code_information":[{"code":"CP17744631831101864","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Teflaro 300mg In 250ml Ns","code_information":[{"code":"CP17744631831106279","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Teflaro 300mg/250ml Ns","code_information":[{"code":"CP17744631831109841","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Teflaro 400 Mg/100 Ml Ns","code_information":[{"code":"CP17744631831108681","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Teflaro 400mg / 250 Ml Ns","code_information":[{"code":"CP17744631831104377","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Teflaro 600 Mg/100 Ml Ns","code_information":[{"code":"CP17744631831104058","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Teflaro 600 Mg/250 Ml Ns","code_information":[{"code":"CP17744631831109179","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Teflaro 600mg In  Ns 100ml","code_information":[{"code":"CP17744631831108222","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Teflaro 600mg/ Ns 100ml","code_information":[{"code":"CP17744631831107092","type":"CDM"},{"code":"250","type":"RC"},{"code":"45606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":433,"maximum":541,"gross_charge":541,"discounted_cash":541,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":541},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Teriparatide Inj 600/2.4","code_information":[{"code":"CP17744631831116529","type":"CDM"},{"code":"250","type":"RC"},{"code":"93110","type":"CPT","modifier":"616"}],"standard_charges":[{"setting":"outpatient","modifier_code":["616"],"minimum":431,"maximum":539,"gross_charge":539,"discounted_cash":539,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":539},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":431},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":431}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Procrit      Inj 20000/ml","code_information":[{"code":"CP17744631830834328","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676032004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":428,"maximum":535,"gross_charge":535,"discounted_cash":535,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":535},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428}]}],"drug_information":{"unit":20000,"type":"EA"}},{"description":"Imbruvica    Tab 420mg","code_information":[{"code":"CP17744631830136021","type":"CDM"},{"code":"250","type":"RC"},{"code":"57962042028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":427,"maximum":534,"gross_charge":534,"discounted_cash":534,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":534},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":427},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":427}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Estring      Mis 2mg","code_information":[{"code":"CP17744631829829610","type":"CDM"},{"code":"250","type":"RC"},{"code":"13215","type":"CPT","modifier":"36"}],"standard_charges":[{"setting":"outpatient","modifier_code":["36"],"minimum":424,"maximum":530,"gross_charge":530,"discounted_cash":530,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":530},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":424},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":424}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ajovy        Inj 225/1.5","code_information":[{"code":"CP17744631828370775","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759020222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":423,"maximum":529,"gross_charge":529,"discounted_cash":529,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":423},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":423}]}],"drug_information":{"unit":225,"type":"EA"}},{"description":"Ajovy        Inj 225/1.5","code_information":[{"code":"CP17744631828374901","type":"CDM"},{"code":"250","type":"RC"},{"code":"51759020410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":423,"maximum":529,"gross_charge":529,"discounted_cash":529,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":529},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":423},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":423}]}],"drug_information":{"unit":225,"type":"EA"}},{"description":"Austedo Xr   Tab 42mg Er","code_information":[{"code":"CP17744631828793288","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":422,"maximum":528,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":42,"type":"ME"}},{"description":"Austedo Xr   Tab 48mg Er","code_information":[{"code":"CP17744631828798197","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047656","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":422,"maximum":528,"gross_charge":528,"discounted_cash":528,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":528},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Spiriva      Spr 2.5mcg","code_information":[{"code":"CP17744631831056094","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":527,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva 2.5mcg Inhaler","code_information":[{"code":"CP17744631831051834","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":527,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva 2.5mcg Inhaler (Big)","code_information":[{"code":"CP17744631831050956","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":527,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva Resp 2.5mcg (60 Inh)","code_information":[{"code":"CP17744631831051976","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":527,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva Resp 2.5mcg 60 Inh","code_information":[{"code":"CP17744631831057797","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":527,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva Respimat-2.5mcg/act(60","code_information":[{"code":"CP17744631831051421","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":422,"maximum":527,"gross_charge":527,"discounted_cash":527,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":527},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Erleada      Tab 240mg","code_information":[{"code":"CP17744631829794655","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676060430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":419,"maximum":524,"gross_charge":524,"discounted_cash":524,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":524},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":419},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":419}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Dificid      Tab 200mg","code_information":[{"code":"CP17744631829601151","type":"CDM"},{"code":"250","type":"RC"},{"code":"52015008001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":417,"maximum":521,"gross_charge":521,"discounted_cash":521,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Dificid 200mg Tabs","code_information":[{"code":"CP17744631829601720","type":"CDM"},{"code":"250","type":"RC"},{"code":"52015008001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":417,"maximum":521,"gross_charge":521,"discounted_cash":521,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":521},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":417},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":417}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Samsca       Tab 15mg","code_information":[{"code":"CP17744631830994832","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148002050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":416,"maximum":520,"gross_charge":520,"discounted_cash":520,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":520},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":416},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":416}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Combivent    Aer 20-100","code_information":[{"code":"CP17744631829415921","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":415,"maximum":519,"gross_charge":519,"discounted_cash":519,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Combivent  20-100mcg 120inh","code_information":[{"code":"CP17744631829419757","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":415,"maximum":519,"gross_charge":519,"discounted_cash":519,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Combivent 20-100mcg (120inh)","code_information":[{"code":"CP17744631829414574","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":415,"maximum":519,"gross_charge":519,"discounted_cash":519,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Combivent 20-100mcg Inhaler","code_information":[{"code":"CP17744631829410494","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":415,"maximum":519,"gross_charge":519,"discounted_cash":519,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":519},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":415},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":415}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Zegalogue    Inj 0.6/0.6","code_information":[{"code":"CP17744631831399529","type":"CDM"},{"code":"250","type":"RC"},{"code":"16919","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":412,"maximum":515,"gross_charge":515,"discounted_cash":515,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":515},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":412},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":412}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Erivedge     Cap 150mg","code_information":[{"code":"CP17744631829797090","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242014001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":406,"maximum":507,"gross_charge":507,"discounted_cash":507,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":507},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":406},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":406}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ovidrel      Inj","code_information":[{"code":"CP17744631830694047","type":"CDM"},{"code":"250","type":"RC"},{"code":"44087115001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":403,"maximum":504,"gross_charge":504,"discounted_cash":504,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":504},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":403},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":403}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levothyroxin Inj 500mcg","code_information":[{"code":"CP17744631830315180","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323064810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":402,"maximum":503,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bexsero      Inj","code_information":[{"code":"CP17744631828875391","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160097620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":402,"maximum":503,"gross_charge":503,"discounted_cash":503,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":503},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xerava       Inj 100mg","code_information":[{"code":"CP17744631831383251","type":"CDM"},{"code":"250","type":"RC"},{"code":"71773010012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":400,"maximum":500,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Xerava 60mg In 250ml Nss","code_information":[{"code":"CP17744631831389842","type":"CDM"},{"code":"250","type":"RC"},{"code":"71773010012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":400,"maximum":500,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Xerava 70 Mg/250 Ml Ns","code_information":[{"code":"CP17744631831383407","type":"CDM"},{"code":"250","type":"RC"},{"code":"71773010012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":400,"maximum":500,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Xerava 90mg/250ml Nss","code_information":[{"code":"CP17744631831389238","type":"CDM"},{"code":"250","type":"RC"},{"code":"71773010012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":400,"maximum":500,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Xerava80mg/250mlns","code_information":[{"code":"CP17744631831380026","type":"CDM"},{"code":"250","type":"RC"},{"code":"71773010012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":400,"maximum":500,"gross_charge":500,"discounted_cash":500,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":500},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Otrexup      Inj 10mg","code_information":[{"code":"CP17744631830690969","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436001004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":397,"maximum":496,"gross_charge":496,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Otrexup      Inj 12.5/0.4","code_information":[{"code":"CP17744631830696729","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436001204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":397,"maximum":496,"gross_charge":496,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Otrexup      Inj 15mg","code_information":[{"code":"CP17744631830696071","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436001504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":397,"maximum":496,"gross_charge":496,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Otrexup      Inj 22.5/0.4","code_information":[{"code":"CP17744631830691187","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436002204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":397,"maximum":496,"gross_charge":496,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397}]}],"drug_information":{"unit":225,"type":"EA"}},{"description":"Otrexup      Inj 25mg","code_information":[{"code":"CP17744631830691409","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436002504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":397,"maximum":496,"gross_charge":496,"discounted_cash":496,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":496},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":397},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":397}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sivextro     Tab 200mg","code_information":[{"code":"CP17744631831028432","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919004104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":394,"maximum":493,"gross_charge":493,"discounted_cash":493,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Apokyn       Inj 10mg/ml","code_information":[{"code":"CP17744631828734087","type":"CDM"},{"code":"250","type":"RC"},{"code":"27505000405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":394,"maximum":493,"gross_charge":493,"discounted_cash":493,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":493},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":394},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":394}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Firmagon     Inj 80mg","code_information":[{"code":"CP17744631829955814","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566830301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":390,"maximum":488,"gross_charge":488,"discounted_cash":488,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":488},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Releuko      Inj 300mcg","code_information":[{"code":"CP17744631830884388","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121156801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":390,"maximum":487,"gross_charge":487,"discounted_cash":487,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Releuko Inj Pfs 300mcg/0.5ml","code_information":[{"code":"CP17744631830888397","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121156801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":390,"maximum":487,"gross_charge":487,"discounted_cash":487,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":487},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":390},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":390}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Gleostine    Cap 40mg","code_information":[{"code":"CP17744631830036073","type":"CDM"},{"code":"250","type":"RC"},{"code":"58181304105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":389,"maximum":486,"gross_charge":486,"discounted_cash":486,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":486},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":389},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":389}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rasuvo       Inj 15mg","code_information":[{"code":"CP17744631830877528","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137052004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":387,"maximum":484,"gross_charge":484,"discounted_cash":484,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":484},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":387},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":387}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Vaxneuvance  Inj","code_information":[{"code":"CP17744631831254594","type":"CDM"},{"code":"250","type":"RC"},{"code":"64329","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":385,"maximum":481,"gross_charge":481,"discounted_cash":481,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vaxneuvance Pfs 0.5ml Dose","code_information":[{"code":"CP17744631831256978","type":"CDM"},{"code":"250","type":"RC"},{"code":"64329","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":385,"maximum":481,"gross_charge":481,"discounted_cash":481,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":481},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Oxycontin    Tab 80mg Cr","code_information":[{"code":"CP17744631830722734","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011048010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":384,"maximum":480,"gross_charge":480,"discounted_cash":480,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Oxycontin    Tab 80mg Er","code_information":[{"code":"CP17744631830726575","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011048010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":384,"maximum":480,"gross_charge":480,"discounted_cash":480,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Oxycontin Er 80mg Tabs","code_information":[{"code":"CP17744631830722467","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011048010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":384,"maximum":480,"gross_charge":480,"discounted_cash":480,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":480},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":384},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":384}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Vaxneuvance  Inj","code_information":[{"code":"CP17744631831255004","type":"CDM"},{"code":"250","type":"RC"},{"code":"64329","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":378,"maximum":473,"gross_charge":473,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rinvoq       Tab 45mg Er","code_information":[{"code":"CP17744631830890003","type":"CDM"},{"code":"250","type":"RC"},{"code":"74104","type":"CPT","modifier":"328"}],"standard_charges":[{"setting":"outpatient","modifier_code":["328"],"minimum":378,"maximum":473,"gross_charge":473,"discounted_cash":473,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":473},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Promacta     Tab 50mg","code_information":[{"code":"CP17744631830849775","type":"CDM"},{"code":"250","type":"RC"},{"code":"78068","type":"CPT","modifier":"655"}],"standard_charges":[{"setting":"outpatient","modifier_code":["655"],"minimum":378,"maximum":472,"gross_charge":472,"discounted_cash":472,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Promacta     Tab 50mg","code_information":[{"code":"CP17744631830844936","type":"CDM"},{"code":"250","type":"RC"},{"code":"78068","type":"CPT","modifier":"615"}],"standard_charges":[{"setting":"outpatient","modifier_code":["615"],"minimum":378,"maximum":472,"gross_charge":472,"discounted_cash":472,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":472},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":378},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":378}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Adalimu-aaty Kit 40/0.4ml","code_information":[{"code":"CP17744631828341493","type":"CDM"},{"code":"250","type":"RC"},{"code":"72606002206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":374,"maximum":467,"gross_charge":467,"discounted_cash":467,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Prevnar 13   Inj","code_information":[{"code":"CP17744631830831778","type":"CDM"},{"code":"250","type":"RC"},{"code":"51971","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":374,"maximum":467,"gross_charge":467,"discounted_cash":467,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374}]}],"drug_information":{"unit":13,"type":"EA"}},{"description":"Relistor     Inj 8/0.4ml","code_information":[{"code":"CP17744631830885844","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649055204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":374,"maximum":467,"gross_charge":467,"discounted_cash":467,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":467},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":374},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":374}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Aranesp      Inj 60mcg","code_information":[{"code":"CP17744631828738746","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513000404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":371,"maximum":464,"gross_charge":464,"discounted_cash":464,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":464},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":371},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":371}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Aranesp      Inj 25mcg","code_information":[{"code":"CP17744631828736277","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513005704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":369,"maximum":461,"gross_charge":461,"discounted_cash":461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Aranesp Pfs 25mcg 0.42ml Dose","code_information":[{"code":"CP17744631828732369","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513005704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":369,"maximum":461,"gross_charge":461,"discounted_cash":461,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":461},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sitavig      Tab 50mg","code_information":[{"code":"CP17744631831024714","type":"CDM"},{"code":"250","type":"RC"},{"code":"71403004902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":366,"maximum":458,"gross_charge":458,"discounted_cash":458,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":458},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":366},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":366}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Prevnar 13   Inj","code_information":[{"code":"CP17744631830834580","type":"CDM"},{"code":"250","type":"RC"},{"code":"51971","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":362,"maximum":453,"gross_charge":453,"discounted_cash":453,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362}]}],"drug_information":{"unit":13,"type":"EA"}},{"description":"Prevnar 13 Syringe","code_information":[{"code":"CP17744631830834054","type":"CDM"},{"code":"250","type":"RC"},{"code":"51971","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":362,"maximum":453,"gross_charge":453,"discounted_cash":453,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":453},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Retacrit     Inj 40000unt","code_information":[{"code":"CP17744631830899965","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"904"}],"standard_charges":[{"setting":"outpatient","modifier_code":["904"],"minimum":362,"maximum":452,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362}]}],"drug_information":{"unit":40000,"type":"EA"}},{"description":"Retacrit 40,000unt","code_information":[{"code":"CP17744631830892475","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"904"}],"standard_charges":[{"setting":"outpatient","modifier_code":["904"],"minimum":362,"maximum":452,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eligard      Inj 7.5mg","code_information":[{"code":"CP17744631829770761","type":"CDM"},{"code":"250","type":"RC"},{"code":"62935075680","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":362,"maximum":452,"gross_charge":452,"discounted_cash":452,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":452},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Wegovy       Inj 1.7mg","code_information":[{"code":"CP17744631831378483","type":"CDM"},{"code":"250","type":"RC"},{"code":"16945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":360,"maximum":450,"gross_charge":450,"discounted_cash":450,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":450},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":360},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":360}]}],"drug_information":{"unit":17,"type":"ME"}},{"description":"Austedo Xr   Tab 36mg Er","code_information":[{"code":"CP17744631828795407","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047456","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":352,"maximum":440,"gross_charge":440,"discounted_cash":440,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":440},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352}]}],"drug_information":{"unit":36,"type":"ME"}},{"description":"Airduo Dghlr  113-14 60 Inh","code_information":[{"code":"CP17744631828370649","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310012906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":351,"maximum":439,"gross_charge":439,"discounted_cash":439,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Airduo Dghlr Inh 113-14","code_information":[{"code":"CP17744631828376747","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310012906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":351,"maximum":439,"gross_charge":439,"discounted_cash":439,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":439},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nivestym     Inj 300/0.5","code_information":[{"code":"CP17744631830578380","type":"CDM"},{"code":"250","type":"RC"},{"code":"69029","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":350,"maximum":438,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Nivestym     Inj 480/0.8","code_information":[{"code":"CP17744631830571818","type":"CDM"},{"code":"250","type":"RC"},{"code":"69029","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":350,"maximum":438,"gross_charge":438,"discounted_cash":438,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":438},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":350},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":350}]}],"drug_information":{"unit":480,"type":"EA"}},{"description":"Avycaz       Inj 2-0.5gm","code_information":[{"code":"CP17744631828808909","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Avycaz 0.94g/ Ns 100ml","code_information":[{"code":"CP17744631828805881","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":94,"type":"GR"}},{"description":"Avycaz 1.25g In 100 Ml Ns","code_information":[{"code":"CP17744631828808095","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Avycaz 1.25g/100 Ml Ns","code_information":[{"code":"CP17744631828801642","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Avycaz 1.25g/100 Ml*","code_information":[{"code":"CP17744631828806543","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Avycaz 1g/100 Ml Ns","code_information":[{"code":"CP17744631828806622","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Avycaz 2.5/100ml Ns","code_information":[{"code":"CP17744631828805602","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Avycaz 2.5g/100 Ml Ns","code_information":[{"code":"CP17744631828800846","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Avycaz 2g/100 Ml Ns","code_information":[{"code":"CP17744631828805467","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Avycaz 940 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631828806598","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":940,"type":"ME"}},{"description":"Avycaz 940 Mg/100 Ml Ns","code_information":[{"code":"CP17744631828801678","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":940,"type":"ME"}},{"description":"Avycaz 940/50ml Ns","code_information":[{"code":"CP17744631828803479","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Avycaz 940mg In 50ml","code_information":[{"code":"CP17744631828802798","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":940,"type":"ME"}},{"description":"Avycaz 940mg/100 Ml Ns","code_information":[{"code":"CP17744631828809472","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":940,"type":"ME"}},{"description":"Avycaz 940mg/50ml","code_information":[{"code":"CP17744631828806380","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":940,"type":"ME"}},{"description":"Avycaz0.94g/100ml Qty 1=2 Bags","code_information":[{"code":"CP17744631828806830","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Avycaz1.25g/100ml Qty 1=3bags","code_information":[{"code":"CP17744631828806431","type":"CDM"},{"code":"250","type":"RC"},{"code":"45627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":349,"maximum":436,"gross_charge":436,"discounted_cash":436,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":436},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":349},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":349}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Rabavert     Inj","code_information":[{"code":"CP17744631830879324","type":"CDM"},{"code":"250","type":"RC"},{"code":"50632001001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":348,"maximum":435,"gross_charge":435,"discounted_cash":435,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":435},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":348},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":348}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xenical      Cap 120mg","code_information":[{"code":"CP17744631831384297","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269046090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":346,"maximum":433,"gross_charge":433,"discounted_cash":433,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":433},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":346},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":346}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Comirnaty    Inj 30/0.3ml","code_information":[{"code":"CP17744631829412425","type":"CDM"},{"code":"250","type":"RC"},{"code":"69237","type":"CPT","modifier":"710"}],"standard_charges":[{"setting":"outpatient","modifier_code":["710"],"minimum":344,"maximum":430,"gross_charge":430,"discounted_cash":430,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":430},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Gilenya      Cap 0.5mg","code_information":[{"code":"CP17744631830038823","type":"CDM"},{"code":"250","type":"RC"},{"code":"78060","type":"CPT","modifier":"715"}],"standard_charges":[{"setting":"outpatient","modifier_code":["715"],"minimum":342,"maximum":428,"gross_charge":428,"discounted_cash":428,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":428},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sivextro     Tab 200mg","code_information":[{"code":"CP17744631831026048","type":"CDM"},{"code":"250","type":"RC"},{"code":"72000031006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":338,"maximum":422,"gross_charge":422,"discounted_cash":422,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":422},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":338},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":338}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Flutic/salme Aer 230-21","code_information":[{"code":"CP17744631829988889","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008896","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":326,"maximum":408,"gross_charge":408,"discounted_cash":408,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326}]}],"drug_information":{"unit":230,"type":"EA"}},{"description":"Flutic/salme Aer 230-21 120inh","code_information":[{"code":"CP17744631829986940","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008896","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":326,"maximum":408,"gross_charge":408,"discounted_cash":408,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":408},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326}]}],"drug_information":{"unit":230,"type":"EA"}},{"description":"Breo Ellipta Inh 50-25mcg","code_information":[{"code":"CP17744631828940519","type":"CDM"},{"code":"250","type":"RC"},{"code":"17309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326,"maximum":407,"gross_charge":407,"discounted_cash":407,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":407},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":326},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":326}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Airduo Respi 113-14 60 Inh","code_information":[{"code":"CP17744631828375581","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310081206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":322,"maximum":402,"gross_charge":402,"discounted_cash":402,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Airduo Respi Inh 113-14","code_information":[{"code":"CP17744631828377833","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310081206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":322,"maximum":402,"gross_charge":402,"discounted_cash":402,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":402},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":322},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":322}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comirnaty    Inj 30/0.3ml","code_information":[{"code":"CP17744631829411795","type":"CDM"},{"code":"250","type":"RC"},{"code":"69239","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":320,"maximum":400,"gross_charge":400,"discounted_cash":400,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Comirnaty 2023-24 0.3ml Dose","code_information":[{"code":"CP17744631829416925","type":"CDM"},{"code":"250","type":"RC"},{"code":"69239","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":320,"maximum":400,"gross_charge":400,"discounted_cash":400,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Comirnaty Pfs 30mcg/0.3ml Dose","code_information":[{"code":"CP17744631829419644","type":"CDM"},{"code":"250","type":"RC"},{"code":"69239","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":320,"maximum":400,"gross_charge":400,"discounted_cash":400,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":400},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":320},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":320}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Teriparatide Inj 600/2.4","code_information":[{"code":"CP17744631831119198","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505618800","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":317,"maximum":396,"gross_charge":396,"discounted_cash":396,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":396},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":317},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":317}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Speech Therapy Evaluation","code_information":[{"code":"CP17744631657094181","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":310,"gross_charge":387,"discounted_cash":387,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310}]}]},{"description":"Sivextro     Tab 200mg","code_information":[{"code":"CP17744631831025461","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919004102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":309,"maximum":386,"gross_charge":386,"discounted_cash":386,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":386},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Vevye        Dro 0.1%","code_information":[{"code":"CP17744631831267418","type":"CDM"},{"code":"250","type":"RC"},{"code":"82667090002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":308,"maximum":385,"gross_charge":385,"discounted_cash":385,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":385},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comirnaty    Inj 30/0.3ml","code_information":[{"code":"CP17744631829411270","type":"CDM"},{"code":"250","type":"RC"},{"code":"69236","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":306,"maximum":383,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Comirnaty Sdv 30mcg/0.3ml Dose","code_information":[{"code":"CP17744631829416607","type":"CDM"},{"code":"250","type":"RC"},{"code":"69236","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":306,"maximum":383,"gross_charge":383,"discounted_cash":383,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":383},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Valtoco      Liq 20mg","code_information":[{"code":"CP17744631831226597","type":"CDM"},{"code":"250","type":"RC"},{"code":"72252052004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":306,"maximum":382,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Valtoco      Spr 10mg","code_information":[{"code":"CP17744631831224667","type":"CDM"},{"code":"250","type":"RC"},{"code":"72252051002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":306,"maximum":382,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Valtoco      Spr 15mg","code_information":[{"code":"CP17744631831228064","type":"CDM"},{"code":"250","type":"RC"},{"code":"72252051504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":306,"maximum":382,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Valtoco      Spr 20mg","code_information":[{"code":"CP17744631831223640","type":"CDM"},{"code":"250","type":"RC"},{"code":"72252052004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":306,"maximum":382,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Valtoco      Spr 5mg","code_information":[{"code":"CP17744631831228213","type":"CDM"},{"code":"250","type":"RC"},{"code":"72252050502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":306,"maximum":382,"gross_charge":382,"discounted_cash":382,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":382},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Breztri Aero Aer Sphere","code_information":[{"code":"CP17744631828941952","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":377,"gross_charge":377,"discounted_cash":377,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breztri Aero Sphere 28inh","code_information":[{"code":"CP17744631828948465","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":302,"maximum":377,"gross_charge":377,"discounted_cash":377,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":377},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":302},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":302}]}],"drug_information":{"unit":28,"type":"EA"}},{"description":"Levothyroxin Inj 500mcg","code_information":[{"code":"CP17744631830316839","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860045310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":295,"maximum":369,"gross_charge":369,"discounted_cash":369,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":369},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Azopt        Sus 1% Op","code_information":[{"code":"CP17744631828812453","type":"CDM"},{"code":"250","type":"RC"},{"code":"78072","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":294,"maximum":368,"gross_charge":368,"discounted_cash":368,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":368},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexcom G6    Mis Receiver","code_information":[{"code":"CP17744631829575676","type":"CDM"},{"code":"250","type":"RC"},{"code":"8627009111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":292,"maximum":365,"gross_charge":365,"discounted_cash":365,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":365},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cipro Hc     Sus Otic","code_information":[{"code":"CP17744631829238002","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758008770","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":291,"maximum":364,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cipro Hc     Sus Otic","code_information":[{"code":"CP17744631829233957","type":"CDM"},{"code":"250","type":"RC"},{"code":"78085","type":"CPT","modifier":"526"}],"standard_charges":[{"setting":"outpatient","modifier_code":["526"],"minimum":291,"maximum":364,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rocklatan    Dro","code_information":[{"code":"CP17744631830916126","type":"CDM"},{"code":"250","type":"RC"},{"code":"70727052925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":291,"maximum":364,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rocklatan Drops","code_information":[{"code":"CP17744631830911659","type":"CDM"},{"code":"250","type":"RC"},{"code":"70727052925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":291,"maximum":364,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kisqali      Tab 200dose","code_information":[{"code":"CP17744631830191489","type":"CDM"},{"code":"250","type":"RC"},{"code":"78086","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":291,"maximum":364,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Kisqali      Tab 400dose","code_information":[{"code":"CP17744631830191726","type":"CDM"},{"code":"250","type":"RC"},{"code":"78086","type":"CPT","modifier":"742"}],"standard_charges":[{"setting":"outpatient","modifier_code":["742"],"minimum":291,"maximum":364,"gross_charge":364,"discounted_cash":364,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":364},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Rasuvo       Inj 20mg","code_information":[{"code":"CP17744631830878296","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137053004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":290,"maximum":363,"gross_charge":363,"discounted_cash":363,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Influenza Test Kit","code_information":[{"code":"CP17744631830145105","type":"CDM"},{"code":"250","type":"RC"},{"code":"10767","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":290,"maximum":363,"gross_charge":363,"discounted_cash":363,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":363},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prolensa     Sol 0.07%","code_information":[{"code":"CP17744631830843063","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208060203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":290,"maximum":362,"gross_charge":362,"discounted_cash":362,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290}]}],"drug_information":{"unit":7,"type":"EA"}},{"description":"Prolensa 0.07% Soln","code_information":[{"code":"CP17744631830843938","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208060203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":290,"maximum":362,"gross_charge":362,"discounted_cash":362,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290}]}],"drug_information":{"unit":7,"type":"EA"}},{"description":"Clog Zapper","code_information":[{"code":"CP17744631829373382","type":"CDM"},{"code":"250","type":"RC"},{"code":"20000","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":290,"maximum":362,"gross_charge":362,"discounted_cash":362,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":362},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":290},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":290}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Menquadfi    Inj","code_information":[{"code":"CP17744631830421756","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281059005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":283,"maximum":354,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Byetta       Inj 10mcg","code_information":[{"code":"CP17744631829044778","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":354,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Byetta 10 Mcg/0.04ml Pen2.4ml","code_information":[{"code":"CP17744631829047962","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":354,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Incruse Ellipta-62.5mcg/inh(30","code_information":[{"code":"CP17744631830134792","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":354,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Incruse Elpt Inh 62.5mcg","code_information":[{"code":"CP17744631830139196","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":354,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Incruse Elpt Inh 62.5mcg 30inh","code_information":[{"code":"CP17744631830133332","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":354,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Incruse Elpt Inh 62.5mcg 7 Inh","code_information":[{"code":"CP17744631830134581","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283,"maximum":354,"gross_charge":354,"discounted_cash":354,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":354},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":283},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":283}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Austedo Xr   Tab 30mg Er","code_information":[{"code":"CP17744631828794065","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047356","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":282,"maximum":352,"gross_charge":352,"discounted_cash":352,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":352},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Diastat Acdl Gel 12.5-20","code_information":[{"code":"CP17744631829588101","type":"CDM"},{"code":"250","type":"RC"},{"code":"18706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":351,"gross_charge":351,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Diastat Acdl Gel 5-10mg","code_information":[{"code":"CP17744631829582213","type":"CDM"},{"code":"250","type":"RC"},{"code":"18706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":281,"maximum":351,"gross_charge":351,"discounted_cash":351,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":351},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rhopressa    Sol 0.02%","code_information":[{"code":"CP17744631830899811","type":"CDM"},{"code":"250","type":"RC"},{"code":"70727049725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":275,"maximum":344,"gross_charge":344,"discounted_cash":344,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":344},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dulera       Aer 50-5mcg","code_information":[{"code":"CP17744631829751766","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dulera  Aer 50-5mcg 120 Inh","code_information":[{"code":"CP17744631829755627","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ozempic      Inj 4mg/3ml","code_information":[{"code":"CP17744631830728041","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ozempic      Inj 8mg/3ml","code_information":[{"code":"CP17744631830728349","type":"CDM"},{"code":"250","type":"RC"},{"code":"16947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ozempic (1 Mg/dose) 4mg/3ml","code_information":[{"code":"CP17744631830726755","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ozempic (2mg/dose) 8mg/3ml","code_information":[{"code":"CP17744631830723858","type":"CDM"},{"code":"250","type":"RC"},{"code":"16947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ozempic 1mg Dose","code_information":[{"code":"CP17744631830721407","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ozempic 1mg Dose 4mg/3ml","code_information":[{"code":"CP17744631830727310","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ozempic 1mg/dose","code_information":[{"code":"CP17744631830720521","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ozempic 2 Mg/dose","code_information":[{"code":"CP17744631830721043","type":"CDM"},{"code":"250","type":"RC"},{"code":"16947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ozempic 2 Mg/dose (8 Mg/3 Ml)","code_information":[{"code":"CP17744631830728233","type":"CDM"},{"code":"250","type":"RC"},{"code":"16947","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274,"maximum":343,"gross_charge":343,"discounted_cash":343,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":343},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nayzilam     Spr 5mg","code_information":[{"code":"CP17744631830544067","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474050015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":274,"maximum":342,"gross_charge":342,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nayzilam5mg/0.1ml 1bx=2u-0.2ml","code_information":[{"code":"CP17744631830546710","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474050015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":274,"maximum":342,"gross_charge":342,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Emend        Sus 125mg","code_information":[{"code":"CP17744631829777015","type":"CDM"},{"code":"250","type":"RC"},{"code":"63066","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":274,"maximum":342,"gross_charge":342,"discounted_cash":342,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":342},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":274},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":274}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Gleevec 400mg Tabs","code_information":[{"code":"CP17744631830034387","type":"CDM"},{"code":"250","type":"RC"},{"code":"78064","type":"CPT","modifier":"930"}],"standard_charges":[{"setting":"outpatient","modifier_code":["930"],"minimum":270,"maximum":337,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Wegovy       Inj 2.4mg","code_information":[{"code":"CP17744631831374092","type":"CDM"},{"code":"250","type":"RC"},{"code":"16945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270,"maximum":337,"gross_charge":337,"discounted_cash":337,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":337},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Emend 1mg In 1ml","code_information":[{"code":"CP17744631829770046","type":"CDM"},{"code":"250","type":"RC"},{"code":"63061","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":268,"maximum":335,"gross_charge":335,"discounted_cash":335,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Emend 1mg/1ml","code_information":[{"code":"CP17744631829779416","type":"CDM"},{"code":"250","type":"RC"},{"code":"63061","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":268,"maximum":335,"gross_charge":335,"discounted_cash":335,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":335},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nucynta Er   Tab 150mg","code_information":[{"code":"CP17744631830640424","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510017460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":267,"maximum":334,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Neupogen     Inj 300/0.5","code_information":[{"code":"CP17744631830558671","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513092491","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":267,"maximum":334,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Neupogen Pfs 300mcg/0.5ml Dose","code_information":[{"code":"CP17744631830555444","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513092491","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":267,"maximum":334,"gross_charge":334,"discounted_cash":334,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":334},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Risperdal    Inj 12.5mg","code_information":[{"code":"CP17744631830898942","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458030911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":266,"maximum":332,"gross_charge":332,"discounted_cash":332,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Epogen       Inj 20000/ml","code_information":[{"code":"CP17744631829796384","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513047810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":266,"maximum":332,"gross_charge":332,"discounted_cash":332,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":332},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266}]}],"drug_information":{"unit":20000,"type":"EA"}},{"description":"Xyosted      Inj 100/0.5","code_information":[{"code":"CP17744631831387779","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436020004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":265,"maximum":331,"gross_charge":331,"discounted_cash":331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Xyosted      Inj 50/0.5","code_information":[{"code":"CP17744631831386376","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436025004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":265,"maximum":331,"gross_charge":331,"discounted_cash":331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Xyosted      Inj 75/0.5","code_information":[{"code":"CP17744631831383724","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436027504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":265,"maximum":331,"gross_charge":331,"discounted_cash":331,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":331},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Heplisav-b   Inj 20/0.5ml","code_information":[{"code":"CP17744631830081441","type":"CDM"},{"code":"250","type":"RC"},{"code":"43528000305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":264,"maximum":330,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Heplisav-b Pfs 20/0.5ml Dose","code_information":[{"code":"CP17744631830089303","type":"CDM"},{"code":"250","type":"RC"},{"code":"43528000305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":264,"maximum":330,"gross_charge":330,"discounted_cash":330,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":330},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Trelegy      Aer 100mcg","code_information":[{"code":"CP17744631831162437","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Trelegy      Aer 200mcg","code_information":[{"code":"CP17744631831163366","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Trelegy      Aer Ellipta","code_information":[{"code":"CP17744631831164647","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy      Aer Ellipta","code_information":[{"code":"CP17744631831162419","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Aer 100-62.5-25 14inh","code_information":[{"code":"CP17744631831165103","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Trelegy Aer 100-62.5-25 28inh","code_information":[{"code":"CP17744631831164286","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Trelegy Aer 200-62.5-25 14inh","code_information":[{"code":"CP17744631831168626","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Trelegy Aer 200-62.5-25 28inh","code_information":[{"code":"CP17744631831169398","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Trelegy Elli 200-62.5-25","code_information":[{"code":"CP17744631831168756","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 100 / 14doses","code_information":[{"code":"CP17744631831162626","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 100-62.5-25","code_information":[{"code":"CP17744631831169971","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 100-62.5-25(14","code_information":[{"code":"CP17744631831169784","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 200-62.5-25","code_information":[{"code":"CP17744631831174110","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 200-62.5-25(14","code_information":[{"code":"CP17744631831176277","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260,"maximum":325,"gross_charge":325,"discounted_cash":325,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":325},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":260},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":260}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zeposia      Cap .92mg","code_information":[{"code":"CP17744631831399684","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572082030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":259,"maximum":324,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259}]}],"drug_information":{"unit":92,"type":"ME"}},{"description":"Zeposia      Cap 0.92mg","code_information":[{"code":"CP17744631831393434","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572082030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":259,"maximum":324,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259}]}],"drug_information":{"unit":92,"type":"ME"}},{"description":"Zeposia 7day Cap Str Pack","code_information":[{"code":"CP17744631831399810","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572081007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":259,"maximum":324,"gross_charge":324,"discounted_cash":324,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":324},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aubagio      Tab 14mg","code_information":[{"code":"CP17744631828799367","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468021004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":254,"maximum":318,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Aubagiospecialty Drug Na","code_information":[{"code":"CP17744631828791484","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468021004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":254,"maximum":318,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aubagio-14mg-tabs","code_information":[{"code":"CP17744631828799643","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468021004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":254,"maximum":318,"gross_charge":318,"discounted_cash":318,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":318},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":254},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":254}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Neupogen     Inj 300mcg","code_information":[{"code":"CP17744631830559869","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513053010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":252,"maximum":315,"gross_charge":315,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Leukine      Inj 250mcg","code_information":[{"code":"CP17744631830294831","type":"CDM"},{"code":"250","type":"RC"},{"code":"71837584305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":252,"maximum":315,"gross_charge":315,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ingrezza     Cap 40-80mg","code_information":[{"code":"CP17744631830143508","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370204806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":252,"maximum":315,"gross_charge":315,"discounted_cash":315,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":315},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Neupogen     Inj 480mcg","code_information":[{"code":"CP17744631830559714","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513054610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":250,"maximum":313,"gross_charge":313,"discounted_cash":313,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":313},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Relistor     Inj 12/0.6ml","code_information":[{"code":"CP17744631830880955","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":249,"maximum":311,"gross_charge":311,"discounted_cash":311,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Relistor     Inj 12/0.6ml","code_information":[{"code":"CP17744631830887826","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649055103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":249,"maximum":311,"gross_charge":311,"discounted_cash":311,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":311},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Occupational Therapy Evaluation","code_information":[{"code":"CP17744631657087849","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":248,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248}]}]},{"description":"Aranesp      Inj 40mcg","code_information":[{"code":"CP17744631828737883","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513000304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":248,"maximum":310,"gross_charge":310,"discounted_cash":310,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":310},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":248},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":248}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Prevnar 20   Inj","code_information":[{"code":"CP17744631830831105","type":"CDM"},{"code":"250","type":"RC"},{"code":"52000","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":247,"maximum":309,"gross_charge":309,"discounted_cash":309,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Prevnar 20 Pfs (0.5 Ml//dose)","code_information":[{"code":"CP17744631830837206","type":"CDM"},{"code":"250","type":"RC"},{"code":"52000","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":247,"maximum":309,"gross_charge":309,"discounted_cash":309,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Prevnar 20 Pfs 0.5ml Dose","code_information":[{"code":"CP17744631830833931","type":"CDM"},{"code":"250","type":"RC"},{"code":"52000","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":247,"maximum":309,"gross_charge":309,"discounted_cash":309,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":309},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Glucagen     Inj Hypokit","code_information":[{"code":"CP17744631830044549","type":"CDM"},{"code":"250","type":"RC"},{"code":"16970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":308,"gross_charge":308,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glucagen  1 Mg Hypokit =1","code_information":[{"code":"CP17744631830043094","type":"CDM"},{"code":"250","type":"RC"},{"code":"16970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":308,"gross_charge":308,"discounted_cash":308,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":308},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Physical Therapy Evaluation","code_information":[{"code":"CP17744631657090082","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":246,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}]},{"description":"Atrovent Hfa Aer 17mcg","code_information":[{"code":"CP17744631828798363","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":307,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":17,"type":"ME"}},{"description":"Atrovent Hfa Aer 17mcg 200 Inh","code_information":[{"code":"CP17744631828799257","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":307,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":17,"type":"ME"}},{"description":"Atrovent Hfa-17mcg/act(200)","code_information":[{"code":"CP17744631828798469","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246,"maximum":307,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":17,"type":"ME"}},{"description":"Abrysvo      Inj","code_information":[{"code":"CP17744631828148154","type":"CDM"},{"code":"250","type":"RC"},{"code":"69034","type":"CPT","modifier":"405"}],"standard_charges":[{"setting":"outpatient","modifier_code":["405"],"minimum":246,"maximum":307,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Abrysvo      Inj","code_information":[{"code":"CP17744631828142264","type":"CDM"},{"code":"250","type":"RC"},{"code":"69034","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":246,"maximum":307,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Abrysvo 120 Mcg Sdv = 1","code_information":[{"code":"CP17744631828149895","type":"CDM"},{"code":"250","type":"RC"},{"code":"69034","type":"CPT","modifier":"405"}],"standard_charges":[{"setting":"outpatient","modifier_code":["405"],"minimum":246,"maximum":307,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Abrysvo 120 Mcg Sdv = 1","code_information":[{"code":"CP17744631828143383","type":"CDM"},{"code":"250","type":"RC"},{"code":"69034","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":246,"maximum":307,"gross_charge":307,"discounted_cash":307,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":307},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":246},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":246}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Arexvy       Inj 120mcg","code_information":[{"code":"CP17744631828741287","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160084811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":245,"maximum":306,"gross_charge":306,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Arexvy Suv 120mcg Dose=1","code_information":[{"code":"CP17744631828748359","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160084811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":245,"maximum":306,"gross_charge":306,"discounted_cash":306,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":306},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":245},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":245}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Tiotrop Brom Cap 18mcg","code_information":[{"code":"CP17744631831137467","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180096412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":244,"maximum":305,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Tiotropium Cap 18mcg 30inh","code_information":[{"code":"CP17744631831132223","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180096412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":244,"maximum":305,"gross_charge":305,"discounted_cash":305,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":305},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Epipen 2-pak Inj 0.3mg","code_information":[{"code":"CP17744631829790198","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502050002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":243,"maximum":304,"gross_charge":304,"discounted_cash":304,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":304},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Diazepam     Gel 10mg","code_information":[{"code":"CP17744631829583671","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":242,"maximum":303,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diazepam Gel-10mg 1=2 Doses","code_information":[{"code":"CP17744631829583153","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":242,"maximum":303,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diazepam Rectal Gel-10mg(c-iv)","code_information":[{"code":"CP17744631829581497","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":242,"maximum":303,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Kisqali      Tab 600dose","code_information":[{"code":"CP17744631830195912","type":"CDM"},{"code":"250","type":"RC"},{"code":"78087","type":"CPT","modifier":"463"}],"standard_charges":[{"setting":"outpatient","modifier_code":["463"],"minimum":242,"maximum":303,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Jakafi       Tab 10mg","code_information":[{"code":"CP17744631830177115","type":"CDM"},{"code":"250","type":"RC"},{"code":"50881001060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":242,"maximum":303,"gross_charge":303,"discounted_cash":303,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":303},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":242},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":242}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dasatinib    Tab 100mg","code_information":[{"code":"CP17744631829547253","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993023730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":240,"maximum":300,"gross_charge":300,"discounted_cash":300,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":300},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dexcom G7    Mis Receiver","code_information":[{"code":"CP17744631829577248","type":"CDM"},{"code":"250","type":"RC"},{"code":"8627007801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":239,"maximum":299,"gross_charge":299,"discounted_cash":299,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":299},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Baqsimi One  Pow 3mg/dose","code_information":[{"code":"CP17744631828830684","type":"CDM"},{"code":"250","type":"RC"},{"code":"54883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":298,"gross_charge":298,"discounted_cash":298,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Baqsimi Two  Pow 3mg/dose","code_information":[{"code":"CP17744631828830600","type":"CDM"},{"code":"250","type":"RC"},{"code":"54883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":238,"maximum":298,"gross_charge":298,"discounted_cash":298,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":298},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Flutic/salm Aer 115-21 120 Inh","code_information":[{"code":"CP17744631829983266","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008796","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":236,"maximum":295,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236}]}],"drug_information":{"unit":115,"type":"EA"}},{"description":"Flutic/salme Aer 115-21","code_information":[{"code":"CP17744631829982646","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008796","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":236,"maximum":295,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236}]}],"drug_information":{"unit":115,"type":"EA"}},{"description":"Flutic/salme Aer 115-21 60 Inh","code_information":[{"code":"CP17744631829985645","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008796","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":236,"maximum":295,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236}]}],"drug_information":{"unit":115,"type":"EA"}},{"description":"Fondaparinux Inj 7.5/0.6","code_information":[{"code":"CP17744631829994946","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":236,"maximum":295,"gross_charge":295,"discounted_cash":295,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":295},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Ingrezza     Cap 60mg","code_information":[{"code":"CP17744631830144153","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370106001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":235,"maximum":294,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ingrezza     Cap 80mg","code_information":[{"code":"CP17744631830141752","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370108001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":235,"maximum":294,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ingrezza 80mg Caps","code_information":[{"code":"CP17744631830140134","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370108001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":235,"maximum":294,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ingrezza Sprinkle 60 Mg Cap","code_information":[{"code":"CP17744631830144757","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370406001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":235,"maximum":294,"gross_charge":294,"discounted_cash":294,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":294},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Flutic Furoate/vilan 200/25mcg","code_information":[{"code":"CP17744631829986923","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013697","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":293,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Flutic/vilan Inh 200/25 30inh","code_information":[{"code":"CP17744631829987179","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013697","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":293,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/vilan Inh 200/25 60inh","code_information":[{"code":"CP17744631829983712","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013697","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":293,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/vilan Inh 200/25mcg","code_information":[{"code":"CP17744631829986704","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013697","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":293,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Flutic/vilan Inh 200-25","code_information":[{"code":"CP17744631829989656","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013697","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":293,"gross_charge":293,"discounted_cash":293,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":293},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xcopri       Tab 200mg","code_information":[{"code":"CP17744631831388337","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699020030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":292,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Repatha      Inj 140mg/ml","code_information":[{"code":"CP17744631830891914","type":"CDM"},{"code":"250","type":"RC"},{"code":"72511075001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":292,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Repatha      Inj 140mg/ml","code_information":[{"code":"CP17744631830892691","type":"CDM"},{"code":"250","type":"RC"},{"code":"72511050101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":292,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Repatha Sure Inj 140mg/ml","code_information":[{"code":"CP17744631830890232","type":"CDM"},{"code":"250","type":"RC"},{"code":"72511076002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":234,"maximum":292,"gross_charge":292,"discounted_cash":292,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":292},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Rasuvo       Inj 25mg","code_information":[{"code":"CP17744631830873296","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137054004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":233,"maximum":291,"gross_charge":291,"discounted_cash":291,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":291},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":233},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":233}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Wheelchair 22\" Bariatric","code_information":[{"code":"CP17744631831371848","type":"CDM"},{"code":"250","type":"RC"},{"code":"71707610627","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":231,"maximum":289,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wheelchair K7 Bariatric","code_information":[{"code":"CP17744631831373717","type":"CDM"},{"code":"250","type":"RC"},{"code":"47949711360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":231,"maximum":289,"gross_charge":289,"discounted_cash":289,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":289},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Liraglutide  Inj 18mg/3ml","code_information":[{"code":"CP17744631830346386","type":"CDM"},{"code":"250","type":"RC"},{"code":"48036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230,"maximum":288,"gross_charge":288,"discounted_cash":288,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":288},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":230},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":230}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Tudorza 400mcg(30-ds)","code_information":[{"code":"CP17744631831196852","type":"CDM"},{"code":"250","type":"RC"},{"code":"72124000202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":229,"maximum":286,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tudorza Pres Aer 400/act","code_information":[{"code":"CP17744631831196388","type":"CDM"},{"code":"250","type":"RC"},{"code":"72124000202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":229,"maximum":286,"gross_charge":286,"discounted_cash":286,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":286},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Linzess      Cap 145mcg","code_information":[{"code":"CP17744631830345993","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":282,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Linzess 145mcg Caps","code_information":[{"code":"CP17744631830342132","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":226,"maximum":282,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Tarceva 150mg Tabs","code_information":[{"code":"CP17744631831106578","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242006401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":226,"maximum":282,"gross_charge":282,"discounted_cash":282,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":282},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Baqsimi Nasal 3mg/dose Pack=1","code_information":[{"code":"CP17744631828835009","type":"CDM"},{"code":"250","type":"RC"},{"code":"26145","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":225,"maximum":281,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Baqsimi Nasal 3mg/dose Pack=2","code_information":[{"code":"CP17744631828831626","type":"CDM"},{"code":"250","type":"RC"},{"code":"26145","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":225,"maximum":281,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Baqsimi One  Pow 3mg/dose","code_information":[{"code":"CP17744631828834983","type":"CDM"},{"code":"250","type":"RC"},{"code":"26145","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":225,"maximum":281,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Baqsimi Two  Pow 3mg/dose","code_information":[{"code":"CP17744631828839549","type":"CDM"},{"code":"250","type":"RC"},{"code":"26145","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":225,"maximum":281,"gross_charge":281,"discounted_cash":281,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":281},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Sofos/velpa Tab 400mg/100mg","code_information":[{"code":"CP17744631831050215","type":"CDM"},{"code":"250","type":"RC"},{"code":"72626270101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":223,"maximum":279,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Sofos/velpat Tab 400-100","code_information":[{"code":"CP17744631831050188","type":"CDM"},{"code":"250","type":"RC"},{"code":"72626270101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":223,"maximum":279,"gross_charge":279,"discounted_cash":279,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":279},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":223},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":223}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Mounjaro     Inj 10mg/0.5","code_information":[{"code":"CP17744631830516521","type":"CDM"},{"code":"250","type":"RC"},{"code":"21471","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mounjaro     Inj 2.5/0.5","code_information":[{"code":"CP17744631830517928","type":"CDM"},{"code":"250","type":"RC"},{"code":"21506","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Mounjaro     Inj 5mg/0.5","code_information":[{"code":"CP17744631830512406","type":"CDM"},{"code":"250","type":"RC"},{"code":"21495","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mounjaro Pen 10 Mg/0.5ml Dose","code_information":[{"code":"CP17744631830510826","type":"CDM"},{"code":"250","type":"RC"},{"code":"21471","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mounjaro Pen 2.5 Mg/0.5ml Dose","code_information":[{"code":"CP17744631830516537","type":"CDM"},{"code":"250","type":"RC"},{"code":"21506","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mounjaro Pen 5 Mg/0.5ml Dose","code_information":[{"code":"CP17744631830519134","type":"CDM"},{"code":"250","type":"RC"},{"code":"21495","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Breo Ellipta  100-25  (30 Inh)","code_information":[{"code":"CP17744631828949970","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  100-25  (60 Inh)","code_information":[{"code":"CP17744631828943190","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic Furoate/vilan 100/25mcg","code_information":[{"code":"CP17744631829985682","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Flutic/vilan Inh 100/25 30inh","code_information":[{"code":"CP17744631829988527","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/vilan Inh 100/25 60inh","code_information":[{"code":"CP17744631829986023","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/vilan Inh 100/25mcg","code_information":[{"code":"CP17744631829986621","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Flutic/vilan Inh 100/25mcg(30)","code_information":[{"code":"CP17744631829983345","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Flutic/vilan Inh 100-25","code_information":[{"code":"CP17744631829984259","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/vilan Inh 100-25mcg","code_information":[{"code":"CP17744631829988398","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993013597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":222,"maximum":278,"gross_charge":278,"discounted_cash":278,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":278},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":222},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":222}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Risperidone  Inj 12.5mg","code_information":[{"code":"CP17744631830909412","type":"CDM"},{"code":"250","type":"RC"},{"code":"48015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221,"maximum":276,"gross_charge":276,"discounted_cash":276,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":276},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Miebo        Dro 1.3gm/ml","code_information":[{"code":"CP17744631830489234","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208037705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":220,"maximum":275,"gross_charge":275,"discounted_cash":275,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":275},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220}]}],"drug_information":{"unit":13,"type":"GR"}},{"description":"Victoza      Inj 18mg/3ml","code_information":[{"code":"CP17744631831268010","type":"CDM"},{"code":"250","type":"RC"},{"code":"16940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":272,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Victoza      Inj 18mg/3ml","code_information":[{"code":"CP17744631831266458","type":"CDM"},{"code":"250","type":"RC"},{"code":"16940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":272,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Victoza 18 Mg/3 Ml Pen 3ml","code_information":[{"code":"CP17744631831265214","type":"CDM"},{"code":"250","type":"RC"},{"code":"16940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":272,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Victoza 18 Mg/3 Ml Pen 3ml","code_information":[{"code":"CP17744631831263808","type":"CDM"},{"code":"250","type":"RC"},{"code":"16940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":218,"maximum":272,"gross_charge":272,"discounted_cash":272,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":272},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Nuzyra       Tab 150mg","code_information":[{"code":"CP17744631830644012","type":"CDM"},{"code":"250","type":"RC"},{"code":"71715000227","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":217,"maximum":271,"gross_charge":271,"discounted_cash":271,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":271},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Teflaro      Inj 400mg","code_information":[{"code":"CP17744631831105740","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Teflaro 200mg D5w 250ml","code_information":[{"code":"CP17744631831109158","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Teflaro 200mg In 250ml Ns","code_information":[{"code":"CP17744631831109192","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Teflaro 200mg/250ml Ns","code_information":[{"code":"CP17744631831101390","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Teflaro 300mg/250ml Ns","code_information":[{"code":"CP17744631831107460","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Teflaro 400 Mg/100 Ml Ns","code_information":[{"code":"CP17744631831100755","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Teflaro 400mg / 100ml Ns Mb","code_information":[{"code":"CP17744631831108158","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Teflaro 400mg In 250ml 0.9% Ns","code_information":[{"code":"CP17744631831103841","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Teflaro 400mg In 250ml Ns","code_information":[{"code":"CP17744631831105837","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Teflaro 400mg/250ml Ns","code_information":[{"code":"CP17744631831105343","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Xerese       Cre 5-1%","code_information":[{"code":"CP17744631831385409","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Tudorza Pr Aer 400/act 30inh","code_information":[{"code":"CP17744631831192078","type":"CDM"},{"code":"250","type":"RC"},{"code":"31008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Tudorza Pres Aer 400/act","code_information":[{"code":"CP17744631831207014","type":"CDM"},{"code":"250","type":"RC"},{"code":"31008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Tudorza Pres Aer 400/act","code_information":[{"code":"CP17744631831205190","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515000202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Lumigan      Sol 0.01%","code_information":[{"code":"CP17744631830380689","type":"CDM"},{"code":"250","type":"RC"},{"code":"23320","type":"CPT","modifier":"503"}],"standard_charges":[{"setting":"outpatient","modifier_code":["503"],"minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lumigan      Sol 0.01% Op","code_information":[{"code":"CP17744631830384675","type":"CDM"},{"code":"250","type":"RC"},{"code":"23320","type":"CPT","modifier":"503"}],"standard_charges":[{"setting":"outpatient","modifier_code":["503"],"minimum":216,"maximum":270,"gross_charge":270,"discounted_cash":270,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":270},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nurtec       Tab 75mg Odt","code_information":[{"code":"CP17744631830642077","type":"CDM"},{"code":"250","type":"RC"},{"code":"72618300002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":215,"maximum":269,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Praluent     Inj 150mg/ml","code_information":[{"code":"CP17744631830805234","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":215,"maximum":269,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Praluent     Inj 75mg/ml","code_information":[{"code":"CP17744631830809093","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755002002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":215,"maximum":269,"gross_charge":269,"discounted_cash":269,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":269},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Ingrezza     Cap 40mg","code_information":[{"code":"CP17744631830143247","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370204001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":268,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ingrezza     Cap 40mg","code_information":[{"code":"CP17744631830149269","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370404001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":268,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ingrezza 40 Mg Sprinkle Cap","code_information":[{"code":"CP17744631830149095","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370404001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":268,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ingrezza 40mg-caps","code_information":[{"code":"CP17744631830148558","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370204001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":268,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ingrezza Sprnkl 40mg Cap","code_information":[{"code":"CP17744631830145046","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370404001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":268,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Xultophy     Inj 100/3.6","code_information":[{"code":"CP17744631831387730","type":"CDM"},{"code":"250","type":"RC"},{"code":"16929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":268,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Xultophy 100/3.6 Pen 3ml","code_information":[{"code":"CP17744631831382155","type":"CDM"},{"code":"250","type":"RC"},{"code":"16929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":214,"maximum":268,"gross_charge":268,"discounted_cash":268,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":268},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Procrit      Inj 10000/ml","code_information":[{"code":"CP17744631830830929","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676031204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":267,"gross_charge":267,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Procrit      Inj 10000/ml","code_information":[{"code":"CP17744631830833485","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":267,"gross_charge":267,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Procrit      Inj 10000/ml","code_information":[{"code":"CP17744631830830550","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676031000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":267,"gross_charge":267,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Procrit 10000unit/ml Soln","code_information":[{"code":"CP17744631830834656","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":267,"gross_charge":267,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":10000,"type":"UN"}},{"description":"Procrit 10'000unit/ml Soln","code_information":[{"code":"CP17744631830836732","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":214,"maximum":267,"gross_charge":267,"discounted_cash":267,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":267},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214}]}],"drug_information":{"unit":1,"type":"UN"}},{"description":"Minocin 200 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830482429","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842016010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":213,"maximum":266,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Minocin100mg In 250 Ml Lr","code_information":[{"code":"CP17744631830489251","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842016010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":213,"maximum":266,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline 200 Mg In 100ml Ns","code_information":[{"code":"CP17744631830489444","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842016010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":213,"maximum":266,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Minocycline 200 Mg In 100ml Ns","code_information":[{"code":"CP17744631830485875","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":213,"maximum":266,"gross_charge":266,"discounted_cash":266,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":266},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":213},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":213}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pulmicort    Inh 180mcg","code_information":[{"code":"CP17744631830853830","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269051812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":212,"maximum":265,"gross_charge":265,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Pulmicort    Inh 180mcg","code_information":[{"code":"CP17744631830859084","type":"CDM"},{"code":"250","type":"RC"},{"code":"18609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":265,"gross_charge":265,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Pulmicort  Inh 180mcg 120inh","code_information":[{"code":"CP17744631830854567","type":"CDM"},{"code":"250","type":"RC"},{"code":"18609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":212,"maximum":265,"gross_charge":265,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Pulmicort Flexhlr-180mcg120spr","code_information":[{"code":"CP17744631830857135","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269051812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":212,"maximum":265,"gross_charge":265,"discounted_cash":265,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":265},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":212},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":212}]}],"drug_information":{"unit":180,"type":"EA"}},{"description":"Austedo Xr   Tab 18mg","code_information":[{"code":"CP17744631828798887","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047956","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":211,"maximum":264,"gross_charge":264,"discounted_cash":264,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Austedo Xr   Tab Titr Kit","code_information":[{"code":"CP17744631828794267","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047729","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":211,"maximum":264,"gross_charge":264,"discounted_cash":264,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Austedo Xr   Tab 24mg","code_information":[{"code":"CP17744631828791311","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047256","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":211,"maximum":264,"gross_charge":264,"discounted_cash":264,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":264},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":211},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":211}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Creon        Cap 36000unt","code_information":[{"code":"CP17744631829429510","type":"CDM"},{"code":"250","type":"RC"},{"code":"32301","type":"CPT","modifier":"628"}],"standard_charges":[{"setting":"outpatient","modifier_code":["628"],"minimum":210,"maximum":262,"gross_charge":262,"discounted_cash":262,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":262},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":210},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":210}]}],"drug_information":{"unit":36000,"type":"EA"}},{"description":"Promacta     Pow 25mg","code_information":[{"code":"CP17744631830846662","type":"CDM"},{"code":"250","type":"RC"},{"code":"78069","type":"CPT","modifier":"761"}],"standard_charges":[{"setting":"outpatient","modifier_code":["761"],"minimum":209,"maximum":261,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Promacta     Tab 25mg","code_information":[{"code":"CP17744631830849178","type":"CDM"},{"code":"250","type":"RC"},{"code":"78068","type":"CPT","modifier":"515"}],"standard_charges":[{"setting":"outpatient","modifier_code":["515"],"minimum":209,"maximum":261,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Promacta 25mg Tabs","code_information":[{"code":"CP17744631830845935","type":"CDM"},{"code":"250","type":"RC"},{"code":"78068","type":"CPT","modifier":"515"}],"standard_charges":[{"setting":"outpatient","modifier_code":["515"],"minimum":209,"maximum":261,"gross_charge":261,"discounted_cash":261,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":261},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spikevax     Inj 50/0.5ml","code_information":[{"code":"CP17744631831057530","type":"CDM"},{"code":"250","type":"RC"},{"code":"80777010296","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":207,"maximum":259,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Spikevax     Inj 50/0.5ml","code_information":[{"code":"CP17744631831058527","type":"CDM"},{"code":"250","type":"RC"},{"code":"80777010293","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":207,"maximum":259,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Spikevax 50 Pfs Mcg 0.5ml Dose","code_information":[{"code":"CP17744631831052159","type":"CDM"},{"code":"250","type":"RC"},{"code":"80777010293","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":207,"maximum":259,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Spikevax 50 Pfs Mcg 0.5ml Dose","code_information":[{"code":"CP17744631831059803","type":"CDM"},{"code":"250","type":"RC"},{"code":"80777010296","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":207,"maximum":259,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Glucagon     Kit 1mg","code_information":[{"code":"CP17744631830044130","type":"CDM"},{"code":"250","type":"RC"},{"code":"28031","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":207,"maximum":259,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Glucagon 1mg Emergency Kit","code_information":[{"code":"CP17744631830046379","type":"CDM"},{"code":"250","type":"RC"},{"code":"28031","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":207,"maximum":259,"gross_charge":259,"discounted_cash":259,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":259},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Spikevax     Inj 50/0.5ml","code_information":[{"code":"CP17744631831057518","type":"CDM"},{"code":"250","type":"RC"},{"code":"80777010295","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":205,"maximum":256,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Spikevax 50 Suv Mcg 0.5ml Dose","code_information":[{"code":"CP17744631831051015","type":"CDM"},{"code":"250","type":"RC"},{"code":"80777010295","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":205,"maximum":256,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Xtandi       Tab 80mg","code_information":[{"code":"CP17744631831383333","type":"CDM"},{"code":"250","type":"RC"},{"code":"46907","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":256,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Advair Hfa   Aer 230/21","code_information":[{"code":"CP17744631828351217","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":256,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205}]}],"drug_information":{"unit":230,"type":"EA"}},{"description":"Advair Hfa Aer 230/21 60 Inh","code_information":[{"code":"CP17744631828365735","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":205,"maximum":256,"gross_charge":256,"discounted_cash":256,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":256},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205}]}],"drug_information":{"unit":230,"type":"EA"}},{"description":"Calcitonin   Inj 200/ml","code_information":[{"code":"CP17744631829068890","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023020501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":204,"maximum":255,"gross_charge":255,"discounted_cash":255,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":255},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Trulicity    Inj 0.75/0.5","code_information":[{"code":"CP17744631831190247","type":"CDM"},{"code":"250","type":"RC"},{"code":"21433","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Trulicity    Inj 1.5/0.5","code_information":[{"code":"CP17744631831192476","type":"CDM"},{"code":"250","type":"RC"},{"code":"21434","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Trulicity    Inj 3/0.5","code_information":[{"code":"CP17744631831194625","type":"CDM"},{"code":"250","type":"RC"},{"code":"22236","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Trulicity    Inj 4.5/0.5","code_information":[{"code":"CP17744631831194671","type":"CDM"},{"code":"250","type":"RC"},{"code":"23182","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Trulicity 1.5mg/0.5ml Inj","code_information":[{"code":"CP17744631831199373","type":"CDM"},{"code":"250","type":"RC"},{"code":"21434","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Trulicity Inj 1.5mg/0.5ml Dose","code_information":[{"code":"CP17744631831198510","type":"CDM"},{"code":"250","type":"RC"},{"code":"21434","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Trulicity Inj 3mg/0.5ml Dose","code_information":[{"code":"CP17744631831197608","type":"CDM"},{"code":"250","type":"RC"},{"code":"22236","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Trulicity Inj 4.5mg/0.5ml Dose","code_information":[{"code":"CP17744631831194700","type":"CDM"},{"code":"250","type":"RC"},{"code":"23182","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Trulicity Inj0.75mg/0.5ml Dose","code_information":[{"code":"CP17744631831199003","type":"CDM"},{"code":"250","type":"RC"},{"code":"21433","type":"CPT","modifier":"80"}],"standard_charges":[{"setting":"outpatient","modifier_code":["80"],"minimum":202,"maximum":252,"gross_charge":252,"discounted_cash":252,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":252},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":202},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":202}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Fondaparinux Inj 7.5/0.6","code_information":[{"code":"CP17744631829993621","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111068010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":200,"maximum":250,"gross_charge":250,"discounted_cash":250,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":250},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":200},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":200}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Calquence    Cap 100mg","code_information":[{"code":"CP17744631829094168","type":"CDM"},{"code":"250","type":"RC"},{"code":"31005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199,"maximum":249,"gross_charge":249,"discounted_cash":249,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":249},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cefiderocol Inj 1gm Ns 100ml","code_information":[{"code":"CP17744631829176018","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Fetroja      Inj 1gm","code_information":[{"code":"CP17744631829869769","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Fetroja 1.5 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829945337","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Fetroja 1gm/100ml Ns","code_information":[{"code":"CP17744631829940355","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Fetroja 1gm/50ml Ns Kit","code_information":[{"code":"CP17744631829940013","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Fetroja 2gm In 100 Ml","code_information":[{"code":"CP17744631829942586","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Fetroja 2gm/100 Ml","code_information":[{"code":"CP17744631829942120","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Fetroja 750mg/100 Ml Ns","code_information":[{"code":"CP17744631829945423","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Njfetroja 1gm/100ml Ns","code_information":[{"code":"CP17744631830575448","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630026610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":198,"maximum":247,"gross_charge":247,"discounted_cash":247,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":247},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tobradex St  Sus 0.3-0.05","code_information":[{"code":"CP17744631831143595","type":"CDM"},{"code":"250","type":"RC"},{"code":"71776003505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":195,"maximum":244,"gross_charge":244,"discounted_cash":244,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":244},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Bydureon Bc  Inj 2/0.85ml","code_information":[{"code":"CP17744631829043836","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":243,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194}]}],"drug_information":{"unit":85,"type":"ML"}},{"description":"Bydureon Bc 2 Mg/0.85ml Pen","code_information":[{"code":"CP17744631829048802","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":194,"maximum":243,"gross_charge":243,"discounted_cash":243,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":243},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Vanco 1.25g / 250 Ml Ns Kit","code_information":[{"code":"CP17744631831225761","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Vanco 1.25gm/250ml D5 Vm","code_information":[{"code":"CP17744631831229062","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.25gm/250ml D5w Vm","code_information":[{"code":"CP17744631831225985","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.25gm/250ml Ns Vm","code_information":[{"code":"CP17744631831224397","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.25gm/250ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831222013","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.2gm/250ml D5w","code_information":[{"code":"CP17744631831225144","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Vanco1.25g/500ml","code_information":[{"code":"CP17744631831238969","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin   Inj 1.25gm","code_information":[{"code":"CP17744631831234058","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin   Sol 1.25gm","code_information":[{"code":"CP17744631831236948","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin 1.1 Gm/250 Ml Ns","code_information":[{"code":"CP17744631831239873","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":11,"type":"GR"}},{"description":"Vancomycin 1.1gm/250ml","code_information":[{"code":"CP17744631831237098","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":11,"type":"GR"}},{"description":"Vancomycin 1.25gm/250ml Ns","code_information":[{"code":"CP17744631831237775","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin 1.25gm/250ml Ns Vm","code_information":[{"code":"CP17744631831234167","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin 1.2gm/ns 09% 250ml","code_information":[{"code":"CP17744631831239080","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Vancomycin 1gm/250 Ml Ns_1.25g","code_information":[{"code":"CP17744631831243253","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 2.5gm/ns 0.9% 500ml","code_information":[{"code":"CP17744631831248516","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Vancomycin 50mg/ml","code_information":[{"code":"CP17744631831248983","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin 750 Mg/250 Ml 1.25g","code_information":[{"code":"CP17744631831244362","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":193,"maximum":241,"gross_charge":241,"discounted_cash":241,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":241},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Inrebic      Cap 100mg","code_information":[{"code":"CP17744631830148664","type":"CDM"},{"code":"250","type":"RC"},{"code":"59572072012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":192,"maximum":240,"gross_charge":240,"discounted_cash":240,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":240},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Rydapt       Cap 25mg","code_information":[{"code":"CP17744631830924656","type":"CDM"},{"code":"250","type":"RC"},{"code":"78069","type":"CPT","modifier":"899"}],"standard_charges":[{"setting":"outpatient","modifier_code":["899"],"minimum":191,"maximum":239,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tivicay      Tab 50mg","code_information":[{"code":"CP17744631831130393","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702022813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":191,"maximum":239,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tivicay 50mg Tabs","code_information":[{"code":"CP17744631831131669","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702022813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":191,"maximum":239,"gross_charge":239,"discounted_cash":239,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":239},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sotyktu      Tab 6mg","code_information":[{"code":"CP17744631831050169","type":"CDM"},{"code":"250","type":"RC"},{"code":"30895","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":190,"maximum":238,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Dexcom G6    Mis Transmit","code_information":[{"code":"CP17744631829570876","type":"CDM"},{"code":"250","type":"RC"},{"code":"8627001601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":190,"maximum":238,"gross_charge":238,"discounted_cash":238,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":238},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Copaxone     Inj 20mg/ml","code_information":[{"code":"CP17744631829416625","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546031730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":190,"maximum":237,"gross_charge":237,"discounted_cash":237,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":237},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rinvoq       Tab 15mg Er","code_information":[{"code":"CP17744631830895076","type":"CDM"},{"code":"250","type":"RC"},{"code":"74230","type":"CPT","modifier":"630"}],"standard_charges":[{"setting":"outpatient","modifier_code":["630"],"minimum":189,"maximum":236,"gross_charge":236,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Rinvoq       Tab 30mg Er","code_information":[{"code":"CP17744631830891250","type":"CDM"},{"code":"250","type":"RC"},{"code":"74231","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":189,"maximum":236,"gross_charge":236,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Fluticas Hfa Aer 220 120 Inh","code_information":[{"code":"CP17744631829982393","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008096","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":189,"maximum":236,"gross_charge":236,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189}]}],"drug_information":{"unit":220,"type":"EA"}},{"description":"Fluticas Hfa Aer 220mcg","code_information":[{"code":"CP17744631829988462","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008096","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":189,"maximum":236,"gross_charge":236,"discounted_cash":236,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":236},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Shingrix     Inj 50/0.5ml","code_information":[{"code":"CP17744631831018339","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":188,"maximum":235,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Shingrix     Inj 50mcg","code_information":[{"code":"CP17744631831015599","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":188,"maximum":235,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Shingrix 50 Mcg Sdv Kit=1","code_information":[{"code":"CP17744631831015336","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":188,"maximum":235,"gross_charge":235,"discounted_cash":235,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":235},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":188},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":188}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pneumovax 23 Inj 25/0.5","code_information":[{"code":"CP17744631830780121","type":"CDM"},{"code":"250","type":"RC"},{"code":"64943","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":187,"maximum":234,"gross_charge":234,"discounted_cash":234,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":234},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Myrbetriq    Sus 8mg/ml","code_information":[{"code":"CP17744631830536423","type":"CDM"},{"code":"250","type":"RC"},{"code":"46950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185,"maximum":231,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Wheelchair 24\" Bariatric","code_information":[{"code":"CP17744631831374430","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922334","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":185,"maximum":231,"gross_charge":231,"discounted_cash":231,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":231},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":185},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":185}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vabomere 2gm/250ml 0.9%ns","code_information":[{"code":"CP17744631831214639","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842012006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":183,"maximum":229,"gross_charge":229,"discounted_cash":229,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":229},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Retacrit     Inj 20000uni","code_information":[{"code":"CP17744631830897724","type":"CDM"},{"code":"250","type":"RC"},{"code":"69131","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":181,"maximum":226,"gross_charge":226,"discounted_cash":226,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181}]}],"drug_information":{"unit":20000,"type":"EA"}},{"description":"Retacrit     Inj 20000uni","code_information":[{"code":"CP17744631830897493","type":"CDM"},{"code":"250","type":"RC"},{"code":"69131","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":181,"maximum":226,"gross_charge":226,"discounted_cash":226,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":226},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181}]}],"drug_information":{"unit":20000,"type":"EA"}},{"description":"Praluent     Inj 150mg/ml","code_information":[{"code":"CP17744631830804174","type":"CDM"},{"code":"250","type":"RC"},{"code":"72733590202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":180,"maximum":225,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Praluent     Inj 75mg/ml","code_information":[{"code":"CP17744631830808091","type":"CDM"},{"code":"250","type":"RC"},{"code":"72733590102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":180,"maximum":225,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Asmanex 60   Aer 220mcg","code_information":[{"code":"CP17744631828763068","type":"CDM"},{"code":"250","type":"RC"},{"code":"85134","type":"CPT","modifier":"102"}],"standard_charges":[{"setting":"outpatient","modifier_code":["102"],"minimum":180,"maximum":225,"gross_charge":225,"discounted_cash":225,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":225},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":180},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":180}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Lidocaine/hc Kit 2-2%","code_information":[{"code":"CP17744631830332207","type":"CDM"},{"code":"250","type":"RC"},{"code":"59088081624","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":177,"maximum":221,"gross_charge":221,"discounted_cash":221,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":221},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Creon        Cap 6000unit","code_information":[{"code":"CP17744631829433367","type":"CDM"},{"code":"250","type":"RC"},{"code":"32004","type":"CPT","modifier":"670"}],"standard_charges":[{"setting":"outpatient","modifier_code":["670"],"minimum":176,"maximum":220,"gross_charge":220,"discounted_cash":220,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":220},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176}]}],"drug_information":{"unit":6000,"type":"UN"}},{"description":"Simbrinza    Sus 1-0.2%","code_information":[{"code":"CP17744631831028862","type":"CDM"},{"code":"250","type":"RC"},{"code":"65414","type":"CPT","modifier":"727"}],"standard_charges":[{"setting":"outpatient","modifier_code":["727"],"minimum":174,"maximum":218,"gross_charge":218,"discounted_cash":218,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":218},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mycophenolat Sus 200mg/ml","code_information":[{"code":"CP17744631830525361","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689030708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":174,"maximum":217,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Mycophenolat Sus 200mg/ml","code_information":[{"code":"CP17744631830525304","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714034501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":174,"maximum":217,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Mycophenolat Sus 200mg/ml","code_information":[{"code":"CP17744631830522038","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238159502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":174,"maximum":217,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Mycophenolat Sus 200mg/ml","code_information":[{"code":"CP17744631830524861","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877023022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":174,"maximum":217,"gross_charge":217,"discounted_cash":217,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":217},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":174},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":174}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Shingrix     Inj 50/0.5ml","code_information":[{"code":"CP17744631831017471","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":173,"maximum":216,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Shingrix     Inj 50mcg","code_information":[{"code":"CP17744631831016297","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":173,"maximum":216,"gross_charge":216,"discounted_cash":216,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":216},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":173},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":173}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Glucagon 1 Mg Kit =1","code_information":[{"code":"CP17744631830046523","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323058282","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":172,"maximum":215,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Glucagon Emr Sol 1mg","code_information":[{"code":"CP17744631830041618","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323058282","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":172,"maximum":215,"gross_charge":215,"discounted_cash":215,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":215},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":172},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":172}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Velphoro     Chw 500mg","code_information":[{"code":"CP17744631831251570","type":"CDM"},{"code":"250","type":"RC"},{"code":"49230064551","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":171,"maximum":214,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Xeljanz Xr   Tab 11mg","code_information":[{"code":"CP17744631831383613","type":"CDM"},{"code":"250","type":"RC"},{"code":"69050","type":"CPT","modifier":"130"}],"standard_charges":[{"setting":"outpatient","modifier_code":["130"],"minimum":171,"maximum":214,"gross_charge":214,"discounted_cash":214,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":214},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171}]}],"drug_information":{"unit":11,"type":"ME"}},{"description":"Zytiga       Tab 500mg","code_information":[{"code":"CP17744631831414451","type":"CDM"},{"code":"250","type":"RC"},{"code":"57894019506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":167,"maximum":209,"gross_charge":209,"discounted_cash":209,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":209},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tabrecta     Tab 150mg","code_information":[{"code":"CP17744631831093334","type":"CDM"},{"code":"250","type":"RC"},{"code":"78070","type":"CPT","modifier":"956"}],"standard_charges":[{"setting":"outpatient","modifier_code":["956"],"minimum":166,"maximum":208,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bicillin L-a Inj 2400000","code_information":[{"code":"CP17744631828870801","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793070210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":166,"maximum":208,"gross_charge":208,"discounted_cash":208,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":208},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xdemvy       Dro 0.25%","code_information":[{"code":"CP17744631831389841","type":"CDM"},{"code":"250","type":"RC"},{"code":"81942012501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":166,"maximum":207,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atovaquone   Sus 750/5ml","code_information":[{"code":"CP17744631828792831","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748029901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":166,"maximum":207,"gross_charge":207,"discounted_cash":207,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":207},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Micafungin100mg/100ml Ns","code_information":[{"code":"CP17744631830471175","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323072910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":165,"maximum":206,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Viberzi      Tab 75mg","code_information":[{"code":"CP17744631831260641","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874007560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":165,"maximum":206,"gross_charge":206,"discounted_cash":206,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":206},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Diazepam     Gel 20mg","code_information":[{"code":"CP17744631829588933","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":164,"maximum":205,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Diazepam 20mg Rectal Gel","code_information":[{"code":"CP17744631829580791","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":164,"maximum":205,"gross_charge":205,"discounted_cash":205,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":205},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":164},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":164}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Jublia       Sol 10%","code_information":[{"code":"CP17744631830180639","type":"CDM"},{"code":"250","type":"RC"},{"code":"18754","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":204,"gross_charge":204,"discounted_cash":204,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Jublia       Sol 10%","code_information":[{"code":"CP17744631830187707","type":"CDM"},{"code":"250","type":"RC"},{"code":"18754","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":163,"maximum":204,"gross_charge":204,"discounted_cash":204,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":204},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Bicillin L-a Inj 1200000","code_information":[{"code":"CP17744631828874330","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":162,"maximum":203,"gross_charge":203,"discounted_cash":203,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":203},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tasigna      Cap 150mg","code_information":[{"code":"CP17744631831102730","type":"CDM"},{"code":"250","type":"RC"},{"code":"78059","type":"CPT","modifier":"287"}],"standard_charges":[{"setting":"outpatient","modifier_code":["287"],"minimum":159,"maximum":199,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Tasigna      Cap 200mg","code_information":[{"code":"CP17744631831107982","type":"CDM"},{"code":"250","type":"RC"},{"code":"78052","type":"CPT","modifier":"687"}],"standard_charges":[{"setting":"outpatient","modifier_code":["687"],"minimum":159,"maximum":199,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Solu-medrol  Inj 125mg","code_information":[{"code":"CP17744631831051274","type":"CDM"},{"code":"250","type":"RC"},{"code":"90047","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":159,"maximum":199,"gross_charge":199,"discounted_cash":199,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":199},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":159},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":159}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Pulmicort    Inh 90mcg","code_information":[{"code":"CP17744631830852560","type":"CDM"},{"code":"250","type":"RC"},{"code":"18609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":198,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Pulmicort    Inh 90mcg","code_information":[{"code":"CP17744631830851345","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269050906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":158,"maximum":198,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Pulmicort  Inh 90mcg 60inh","code_information":[{"code":"CP17744631830850780","type":"CDM"},{"code":"250","type":"RC"},{"code":"18609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":198,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Erythrocin 250mg100ml Ns","code_information":[{"code":"CP17744631829809272","type":"CDM"},{"code":"250","type":"RC"},{"code":"40964","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158,"maximum":198,"gross_charge":198,"discounted_cash":198,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":198},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":158},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":158}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Recombiva-hb Inj 40mcg/ml","code_information":[{"code":"CP17744631830881658","type":"CDM"},{"code":"250","type":"RC"},{"code":"64992","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":157,"maximum":196,"gross_charge":196,"discounted_cash":196,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":196},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829995343","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332065530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":156,"maximum":195,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Glucagon     Kit 1mg","code_information":[{"code":"CP17744631830044219","type":"CDM"},{"code":"250","type":"RC"},{"code":"54858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":195,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Glucagon  1 Mg Kit =1","code_information":[{"code":"CP17744631830043419","type":"CDM"},{"code":"250","type":"RC"},{"code":"54858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156,"maximum":195,"gross_charge":195,"discounted_cash":195,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":195},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cathflo Acti Inj 2mg","code_information":[{"code":"CP17744631829140918","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":155,"maximum":194,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Cathflo Acti Inj 2mg","code_information":[{"code":"CP17744631829144656","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242004110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":155,"maximum":194,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Flovent Disk Aer 50mcg","code_information":[{"code":"CP17744631829967754","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":194,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Flovent Dsk 50mcg 60 Inh","code_information":[{"code":"CP17744631829960728","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155,"maximum":194,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aranesp      Inj 10mcg","code_information":[{"code":"CP17744631828736361","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513009804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":155,"maximum":194,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aranesp      Inj 25mcg","code_information":[{"code":"CP17744631828731918","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513000204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":155,"maximum":194,"gross_charge":194,"discounted_cash":194,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":194},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ampicillin   Inj 2gm","code_information":[{"code":"CP17744631828528715","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":193,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gm/100ml Ns Mb Kt","code_information":[{"code":"CP17744631828521732","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":193,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Vanco 1.25 Grams/ 250 Ml","code_information":[{"code":"CP17744631831221731","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":193,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin   Inj 1.25gm","code_information":[{"code":"CP17744631831238566","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":193,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin 1.25gm/250ml Sol","code_information":[{"code":"CP17744631831233271","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":193,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin 1.25gm/250ml Swfi","code_information":[{"code":"CP17744631831232154","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":193,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin Soln 1.25gm/250ml","code_information":[{"code":"CP17744631831242446","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":193,"gross_charge":193,"discounted_cash":193,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":193},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vitamin K1   Inj 1mg/0.5","code_information":[{"code":"CP17744631831303016","type":"CDM"},{"code":"250","type":"RC"},{"code":"40991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Varivax      Inj","code_information":[{"code":"CP17744631831242616","type":"CDM"},{"code":"250","type":"RC"},{"code":"64827","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zerbaxa      Inj 1.5gm","code_information":[{"code":"CP17744631831396014","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Zerbaxa 1.5g/100ml Ns","code_information":[{"code":"CP17744631831398930","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Zerbaxa 3 Gm In 100 Ml Ns","code_information":[{"code":"CP17744631831392378","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Zerbaxa 3 Gm/100 Ml Ns","code_information":[{"code":"CP17744631831397895","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Zerbaxa 3gm/100ml Ns","code_information":[{"code":"CP17744631831390119","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Zerbaxa 450mg/100ml","code_information":[{"code":"CP17744631831390440","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Zerbaxa 750mg In 100ml Ns","code_information":[{"code":"CP17744631831395413","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Zerbaxa 750mg/100ml Ns","code_information":[{"code":"CP17744631831392207","type":"CDM"},{"code":"250","type":"RC"},{"code":"67919003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Asmanex 30   Aer 220mcg","code_information":[{"code":"CP17744631828766036","type":"CDM"},{"code":"250","type":"RC"},{"code":"85134","type":"CPT","modifier":"107"}],"standard_charges":[{"setting":"outpatient","modifier_code":["107"],"minimum":154,"maximum":192,"gross_charge":192,"discounted_cash":192,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":192},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Eraxis       Inj 100mg","code_information":[{"code":"CP17744631829794880","type":"CDM"},{"code":"250","type":"RC"},{"code":"49011","type":"CPT","modifier":"628"}],"standard_charges":[{"setting":"outpatient","modifier_code":["628"],"minimum":153,"maximum":191,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Eraxis 100 Mg In 100 Ns","code_information":[{"code":"CP17744631829796956","type":"CDM"},{"code":"250","type":"RC"},{"code":"49011","type":"CPT","modifier":"628"}],"standard_charges":[{"setting":"outpatient","modifier_code":["628"],"minimum":153,"maximum":191,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Eraxis 100mg100ml Ns","code_information":[{"code":"CP17744631829795838","type":"CDM"},{"code":"250","type":"RC"},{"code":"49011","type":"CPT","modifier":"628"}],"standard_charges":[{"setting":"outpatient","modifier_code":["628"],"minimum":153,"maximum":191,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Asmanex 30   Aer 220mcg","code_information":[{"code":"CP17744631828766099","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":153,"maximum":191,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Asmanex 30  Aer 220mcg (30inh)","code_information":[{"code":"CP17744631828762043","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":153,"maximum":191,"gross_charge":191,"discounted_cash":191,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":191},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":153},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":153}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Novavax      Inj 2024-25","code_information":[{"code":"CP17744631830575403","type":"CDM"},{"code":"250","type":"RC"},{"code":"80631010710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":152,"maximum":190,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Novavax Covid 24-25 Syr","code_information":[{"code":"CP17744631830571218","type":"CDM"},{"code":"250","type":"RC"},{"code":"80631010710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":152,"maximum":190,"gross_charge":190,"discounted_cash":190,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":190},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bebtelovimab Sol 175/2ml","code_information":[{"code":"CP17744631828845888","type":"CDM"},{"code":"250","type":"RC"},{"code":"27589","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":151,"maximum":189,"gross_charge":189,"discounted_cash":189,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":189},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Mycamine     Inj 100mg","code_information":[{"code":"CP17744631830527779","type":"CDM"},{"code":"250","type":"RC"},{"code":"46932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":187,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mycamine 100mg/100ml Ns","code_information":[{"code":"CP17744631830526947","type":"CDM"},{"code":"250","type":"RC"},{"code":"46932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":150,"maximum":187,"gross_charge":187,"discounted_cash":187,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":187},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Firvanq      Sol 50mg/ml","code_information":[{"code":"CP17744631829959563","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628020605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":146,"maximum":183,"gross_charge":183,"discounted_cash":183,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":183},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tice Bcg     Inj","code_information":[{"code":"CP17744631831122854","type":"CDM"},{"code":"250","type":"RC"},{"code":"52060","type":"CPT","modifier":"202"}],"standard_charges":[{"setting":"outpatient","modifier_code":["202"],"minimum":146,"maximum":182,"gross_charge":182,"discounted_cash":182,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":182},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Condylox     Gel 0.5%","code_information":[{"code":"CP17744631829413114","type":"CDM"},{"code":"250","type":"RC"},{"code":"23611","type":"CPT","modifier":"803"}],"standard_charges":[{"setting":"outpatient","modifier_code":["803"],"minimum":145,"maximum":181,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Repatha Push Inj 420/3.5","code_information":[{"code":"CP17744631830894264","type":"CDM"},{"code":"250","type":"RC"},{"code":"72511077001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":145,"maximum":181,"gross_charge":181,"discounted_cash":181,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":181},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145}]}],"drug_information":{"unit":420,"type":"EA"}},{"description":"Soliqua      Inj 100/33","code_information":[{"code":"CP17744631831056222","type":"CDM"},{"code":"250","type":"RC"},{"code":"24576","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":142,"maximum":178,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Soliqua 100/33 Pen 3ml","code_information":[{"code":"CP17744631831050414","type":"CDM"},{"code":"250","type":"RC"},{"code":"24576","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":142,"maximum":178,"gross_charge":178,"discounted_cash":178,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":178},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Nascobal     Spr 500mcg","code_information":[{"code":"CP17744631830540299","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884027082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":142,"maximum":177,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Menveo       Inj","code_information":[{"code":"CP17744631830423409","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160095509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":142,"maximum":177,"gross_charge":177,"discounted_cash":177,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":177},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Austedo Xr   Tab 12mg","code_information":[{"code":"CP17744631828794731","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047156","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":141,"maximum":176,"gross_charge":176,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Upright Rollator","code_information":[{"code":"CP17744631831212153","type":"CDM"},{"code":"250","type":"RC"},{"code":"14966","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":141,"maximum":176,"gross_charge":176,"discounted_cash":176,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":176},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diazepam     Gel 10mg","code_information":[{"code":"CP17744631829582564","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386028001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":140,"maximum":175,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Wixela Inhub Aer 500/50","code_information":[{"code":"CP17744631831377716","type":"CDM"},{"code":"250","type":"RC"},{"code":"37893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":175,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Wixela Inhub Aer 500/50 60 Inh","code_information":[{"code":"CP17744631831374350","type":"CDM"},{"code":"250","type":"RC"},{"code":"37893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":140,"maximum":175,"gross_charge":175,"discounted_cash":175,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":175},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Nuplazid     Cap 34mg","code_information":[{"code":"CP17744631830642673","type":"CDM"},{"code":"250","type":"RC"},{"code":"63090034030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":137,"maximum":171,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137}]}],"drug_information":{"unit":34,"type":"ME"}},{"description":"Nuplazid     Tab 10mg","code_information":[{"code":"CP17744631830642112","type":"CDM"},{"code":"250","type":"RC"},{"code":"63090010030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":137,"maximum":171,"gross_charge":171,"discounted_cash":171,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":171},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Asmanex 120  Aer 220mcg","code_information":[{"code":"CP17744631828760451","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":135,"maximum":169,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Asmanex 120 Aer 220mcg 120inh","code_information":[{"code":"CP17744631828762864","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":135,"maximum":169,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Xofluza      Tab 40mg","code_information":[{"code":"CP17744631831389565","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242086001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":135,"maximum":169,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Xofluza      Tab 80mg","code_information":[{"code":"CP17744631831384089","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242087701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":135,"maximum":169,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Sprycel      Tab 20mg","code_information":[{"code":"CP17744631831066549","type":"CDM"},{"code":"250","type":"RC"},{"code":"30527","type":"CPT","modifier":"11"}],"standard_charges":[{"setting":"outpatient","modifier_code":["11"],"minimum":135,"maximum":169,"gross_charge":169,"discounted_cash":169,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":169},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vasculera    Tab","code_information":[{"code":"CP17744631831253540","type":"CDM"},{"code":"250","type":"RC"},{"code":"68040061014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":134,"maximum":167,"gross_charge":167,"discounted_cash":167,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":167},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epogen       Inj 10000/ml","code_information":[{"code":"CP17744631829799728","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513014401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":133,"maximum":166,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Epogen       Inj 10000/ml","code_information":[{"code":"CP17744631829797728","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513014410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":133,"maximum":166,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Epogen 10000unit/ml Inj","code_information":[{"code":"CP17744631829792213","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513014410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":133,"maximum":166,"gross_charge":166,"discounted_cash":166,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":166},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133}]}],"drug_information":{"unit":10000,"type":"UN"}},{"description":"Wheelchair 20\" 350lbs","code_information":[{"code":"CP17744631831376647","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922324","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":132,"maximum":165,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desoximetas  Oin 0.05%","code_information":[{"code":"CP17744631829567956","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672135203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":132,"maximum":165,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Daptomy/nacl Inj 1000/100","code_information":[{"code":"CP17744631829487402","type":"CDM"},{"code":"250","type":"RC"},{"code":"33807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132,"maximum":165,"gross_charge":165,"discounted_cash":165,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":165},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Austedo Xr   Tab Titr Kit","code_information":[{"code":"CP17744631828792437","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546049052","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":130,"maximum":163,"gross_charge":163,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nuvaring     Mis","code_information":[{"code":"CP17744631830643593","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206014603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":130,"maximum":163,"gross_charge":163,"discounted_cash":163,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":163},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Syndros      Sol 5mg/ml","code_information":[{"code":"CP17744631831087784","type":"CDM"},{"code":"250","type":"RC"},{"code":"78613020130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":130,"maximum":162,"gross_charge":162,"discounted_cash":162,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":162},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rukobia      Tab 600mg Er","code_information":[{"code":"CP17744631830923738","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702025018","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":129,"maximum":161,"gross_charge":161,"discounted_cash":161,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":161},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Budesonide   Sus 1mg/2ml","code_information":[{"code":"CP17744631828968902","type":"CDM"},{"code":"250","type":"RC"},{"code":"93681","type":"CPT","modifier":"773"}],"standard_charges":[{"setting":"outpatient","modifier_code":["773"],"minimum":128,"maximum":160,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Budesonide 1mg/2ml Ihalation","code_information":[{"code":"CP17744631828963034","type":"CDM"},{"code":"250","type":"RC"},{"code":"93681","type":"CPT","modifier":"773"}],"standard_charges":[{"setting":"outpatient","modifier_code":["773"],"minimum":128,"maximum":160,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Budesonide 1mg/2ml Inhalation","code_information":[{"code":"CP17744631828968220","type":"CDM"},{"code":"250","type":"RC"},{"code":"93681","type":"CPT","modifier":"773"}],"standard_charges":[{"setting":"outpatient","modifier_code":["773"],"minimum":128,"maximum":160,"gross_charge":160,"discounted_cash":160,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":160},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Speech Therapy","code_information":[{"code":"CP17744631657095582","type":"CDM"},{"code":"440","type":"RC"},{"code":"92521","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":126,"gross_charge":158,"discounted_cash":158,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}]},{"description":"Symtuza      Tab","code_information":[{"code":"CP17744631831084168","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676080030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Symtuza 800-150-200-10 Mg","code_information":[{"code":"CP17744631831087369","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676080030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Symtuza 800-150-200-10 Mg Tab","code_information":[{"code":"CP17744631831089747","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676080030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Buprenorphin Dis 20mcg/hr","code_information":[{"code":"CP17744631828972082","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858083940","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Mavyret      Tab 100-40mg","code_information":[{"code":"CP17744631830403681","type":"CDM"},{"code":"250","type":"RC"},{"code":"74262","type":"CPT","modifier":"528"}],"standard_charges":[{"setting":"outpatient","modifier_code":["528"],"minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mavyret 100-40mg Tabs","code_information":[{"code":"CP17744631830401848","type":"CDM"},{"code":"250","type":"RC"},{"code":"74262","type":"CPT","modifier":"528"}],"standard_charges":[{"setting":"outpatient","modifier_code":["528"],"minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Creon        Cap 24000unt","code_information":[{"code":"CP17744631829427393","type":"CDM"},{"code":"250","type":"RC"},{"code":"32263","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":24000,"type":"EA"}},{"description":"Breo Ellipta  200-25  (14inh)","code_information":[{"code":"CP17744631828949278","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  200-25  (28inh)","code_information":[{"code":"CP17744631828946130","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta Inh 200-25","code_information":[{"code":"CP17744631828948379","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126,"maximum":157,"gross_charge":157,"discounted_cash":157,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":157},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Advair Hfa   Aer 115/21","code_information":[{"code":"CP17744631828353316","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":156,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125}]}],"drug_information":{"unit":115,"type":"EA"}},{"description":"Advair Hfa Aer 115/21 60 Inh","code_information":[{"code":"CP17744631828357947","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":156,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125}]}],"drug_information":{"unit":115,"type":"EA"}},{"description":"Bexarotene   Cap 75mg","code_information":[{"code":"CP17744631828879206","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682000310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":125,"maximum":156,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Budes/formot Aer 80-4.5","code_information":[{"code":"CP17744631828956734","type":"CDM"},{"code":"250","type":"RC"},{"code":"31073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":156,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Budes/formot Aer 80-4.5 120inh","code_information":[{"code":"CP17744631828952172","type":"CDM"},{"code":"250","type":"RC"},{"code":"31073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":125,"maximum":156,"gross_charge":156,"discounted_cash":156,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":156},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Stribild     Tab","code_information":[{"code":"CP17744631831079429","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958120101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":124,"maximum":155,"gross_charge":155,"discounted_cash":155,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":155},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levothyroxin Inj 200mcg","code_information":[{"code":"CP17744631830317307","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860045210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":123,"maximum":154,"gross_charge":154,"discounted_cash":154,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":154},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":123},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":123}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Cipro (10%)  Sus 500mg/5","code_information":[{"code":"CP17744631829232594","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419077301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":122,"maximum":152,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetylcyst   Sol 10%","code_information":[{"code":"CP17744631828260069","type":"CDM"},{"code":"250","type":"RC"},{"code":"51775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":152,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 10%  4ml Vials","code_information":[{"code":"CP17744631828300135","type":"CDM"},{"code":"250","type":"RC"},{"code":"51775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":152,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Acetylcysteine 10% Soln","code_information":[{"code":"CP17744631828307565","type":"CDM"},{"code":"250","type":"RC"},{"code":"51775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":152,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 10% Soln Vial","code_information":[{"code":"CP17744631828302670","type":"CDM"},{"code":"250","type":"RC"},{"code":"51775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122,"maximum":152,"gross_charge":152,"discounted_cash":152,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":152},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Kerydin      Sol 5%","code_information":[{"code":"CP17744631830183346","type":"CDM"},{"code":"250","type":"RC"},{"code":"10337090510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":121,"maximum":151,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Nitroglycrn  Spr 0.4mg","code_information":[{"code":"CP17744631830571890","type":"CDM"},{"code":"250","type":"RC"},{"code":"28595012012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":121,"maximum":151,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitroglycrn  Spr 400mcg","code_information":[{"code":"CP17744631830570158","type":"CDM"},{"code":"250","type":"RC"},{"code":"28595012012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":121,"maximum":151,"gross_charge":151,"discounted_cash":151,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":151},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Epinephrine  Inj 0.3mg","code_information":[{"code":"CP17744631829792021","type":"CDM"},{"code":"250","type":"RC"},{"code":"93598","type":"CPT","modifier":"627"}],"standard_charges":[{"setting":"outpatient","modifier_code":["627"],"minimum":120,"maximum":150,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Triamcin Ace Inj 200/5ml","code_information":[{"code":"CP17744631831173116","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714014001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":120,"maximum":150,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Budes/formot Aer 160-4.5","code_information":[{"code":"CP17744631828955128","type":"CDM"},{"code":"250","type":"RC"},{"code":"31073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":150,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Budes/formot Aer160-4.5 120inh","code_information":[{"code":"CP17744631828953883","type":"CDM"},{"code":"250","type":"RC"},{"code":"31073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":150,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Budesonid/formotero160-4.5(120","code_information":[{"code":"CP17744631828953498","type":"CDM"},{"code":"250","type":"RC"},{"code":"31073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":150,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Budesonid/formoterol160-4.5(60","code_information":[{"code":"CP17744631828952641","type":"CDM"},{"code":"250","type":"RC"},{"code":"31073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120,"maximum":150,"gross_charge":150,"discounted_cash":150,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":150},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":120},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":120}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles  Mis 31gx5/16","code_information":[{"code":"CP17744631830749505","type":"CDM"},{"code":"250","type":"RC"},{"code":"8489816310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":119,"maximum":149,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles 31g (Dropsafe)","code_information":[{"code":"CP17744631830746041","type":"CDM"},{"code":"250","type":"RC"},{"code":"8489816310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":119,"maximum":149,"gross_charge":149,"discounted_cash":149,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":149},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Genvoya      Tab","code_information":[{"code":"CP17744631830031401","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958190101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":147,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Genvoya Tablet 150-200-10mg","code_information":[{"code":"CP17744631830039279","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958190101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":147,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Genvoya Tabs","code_information":[{"code":"CP17744631830037327","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958190101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":147,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticas Hfa Aer 110 120 Inh","code_information":[{"code":"CP17744631829983521","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993007996","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":147,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":110,"type":"EA"}},{"description":"Fluticas Hfa Aer 110mcg","code_information":[{"code":"CP17744631829987219","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993007996","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":147,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":11,"type":"ME"}},{"description":"Flublok      Inj 2024-25","code_information":[{"code":"CP17744631829960996","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281072410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":147,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Fluzone Hd   Inj 2024-25","code_information":[{"code":"CP17744631829995713","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":118,"maximum":147,"gross_charge":147,"discounted_cash":147,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":147},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Fluticas Hfa Aer 44mcg","code_information":[{"code":"CP17744631829987870","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993007896","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":117,"maximum":146,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}],"drug_information":{"unit":44,"type":"ME"}},{"description":"Fluticas Hfa Aer44 120 Inh","code_information":[{"code":"CP17744631829986778","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993007896","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":117,"maximum":146,"gross_charge":146,"discounted_cash":146,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":146},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117}]}],"drug_information":{"unit":44,"type":"EA"}},{"description":"Tpn W Lipids (<3000ml)","code_information":[{"code":"CP17744631831155839","type":"CDM"},{"code":"250","type":"RC"},{"code":"17191000779","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":116,"maximum":145,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116}]}],"drug_information":{"unit":3000,"type":"ML"}},{"description":"Relizorb     Mis","code_information":[{"code":"CP17744631830885016","type":"CDM"},{"code":"250","type":"RC"},{"code":"62205000020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":116,"maximum":145,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xermelo      Tab 250mg","code_information":[{"code":"CP17744631831389969","type":"CDM"},{"code":"250","type":"RC"},{"code":"70720012585","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":116,"maximum":145,"gross_charge":145,"discounted_cash":145,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":145},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Toujeo Solo  Inj 300/ml","code_information":[{"code":"CP17744631831150022","type":"CDM"},{"code":"250","type":"RC"},{"code":"24586","type":"CPT","modifier":"903"}],"standard_charges":[{"setting":"outpatient","modifier_code":["903"],"minimum":114,"maximum":143,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Toujeo Solo  Inj 300iu/ml","code_information":[{"code":"CP17744631831157956","type":"CDM"},{"code":"250","type":"RC"},{"code":"24586","type":"CPT","modifier":"903"}],"standard_charges":[{"setting":"outpatient","modifier_code":["903"],"minimum":114,"maximum":143,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114}]}],"drug_information":{"unit":300,"type":"F2"}},{"description":"Toujeo Solo 300 Units/ml 1.5ml","code_information":[{"code":"CP17744631831150527","type":"CDM"},{"code":"250","type":"RC"},{"code":"24586","type":"CPT","modifier":"903"}],"standard_charges":[{"setting":"outpatient","modifier_code":["903"],"minimum":114,"maximum":143,"gross_charge":143,"discounted_cash":143,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":143},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114}]}],"drug_information":{"unit":300,"type":"UN"}},{"description":"Twinrix      Inj","code_information":[{"code":"CP17744631831204388","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160081552","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":114,"maximum":142,"gross_charge":142,"discounted_cash":142,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":142},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atovaquone   Sus 750/5ml","code_information":[{"code":"CP17744631828795266","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603024801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Atovaquone   Sus 750/5ml","code_information":[{"code":"CP17744631828795985","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Biktarvy     Tab","code_information":[{"code":"CP17744631828877172","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biktarvy     Tab","code_information":[{"code":"CP17744631828874626","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biktarvy 50/200/25mg Tabs","code_information":[{"code":"CP17744631828878407","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Biktarvy 50/200/25mg Tabs","code_information":[{"code":"CP17744631828871782","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Biktarvy 50-200-25 Mg","code_information":[{"code":"CP17744631828876152","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Biktarvy Tablet 50-200-25 Mg","code_information":[{"code":"CP17744631828877601","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Biktarvy Tb 30/120/15mg","code_information":[{"code":"CP17744631828874233","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Biktarvy--tablet  50-200-25mg","code_information":[{"code":"CP17744631828874296","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958250103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":113,"maximum":141,"gross_charge":141,"discounted_cash":141,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":141},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Treximet     Tab 85-500mg","code_information":[{"code":"CP17744631831172262","type":"CDM"},{"code":"250","type":"RC"},{"code":"42847085009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":112,"maximum":140,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112}]}],"drug_information":{"unit":85,"type":"ME"}},{"description":"Tpn Iv W Lipids (<1000ml)","code_information":[{"code":"CP17744631831152212","type":"CDM"},{"code":"250","type":"RC"},{"code":"17191000799","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":112,"maximum":140,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Prograf      Gra 1mg","code_information":[{"code":"CP17744631830842014","type":"CDM"},{"code":"250","type":"RC"},{"code":"46913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112,"maximum":140,"gross_charge":140,"discounted_cash":140,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":140},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Epinephrine  Inj 0.15mg","code_information":[{"code":"CP17744631829798660","type":"CDM"},{"code":"250","type":"RC"},{"code":"93598","type":"CPT","modifier":"527"}],"standard_charges":[{"setting":"outpatient","modifier_code":["527"],"minimum":111,"maximum":139,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Estrad Val   Inj 20mg/ml","code_information":[{"code":"CP17744631829818748","type":"CDM"},{"code":"250","type":"RC"},{"code":"51704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":111,"maximum":139,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Leuprolide   Kit 14 Day","code_information":[{"code":"CP17744631830296565","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150047801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":111,"maximum":139,"gross_charge":139,"discounted_cash":139,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":139},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Firvanq      Sol 25mg/ml","code_information":[{"code":"CP17744631829953032","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628020405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":110,"maximum":138,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atovaquone   Sus 750/5ml","code_information":[{"code":"CP17744631828794858","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462042121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":110,"maximum":138,"gross_charge":138,"discounted_cash":138,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":138},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Butrans      Dis 20mcg/hr","code_information":[{"code":"CP17744631829046501","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011075204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":110,"maximum":137,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Comirnaty    Inj 2024-25","code_information":[{"code":"CP17744631829411613","type":"CDM"},{"code":"250","type":"RC"},{"code":"69243","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":110,"maximum":137,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Comirnaty 0.1mg -0.3ml Pfs","code_information":[{"code":"CP17744631829418445","type":"CDM"},{"code":"250","type":"RC"},{"code":"69243","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":110,"maximum":137,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Comirnaty 0.1mg Refrf","code_information":[{"code":"CP17744631829412861","type":"CDM"},{"code":"250","type":"RC"},{"code":"69243","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":110,"maximum":137,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Comirnaty 0.3ml Syr 24-25","code_information":[{"code":"CP17744631829412589","type":"CDM"},{"code":"250","type":"RC"},{"code":"69243","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":110,"maximum":137,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Mpb Comirnaty 0.1mg Refrf","code_information":[{"code":"CP17744631830516034","type":"CDM"},{"code":"250","type":"RC"},{"code":"69243","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":110,"maximum":137,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Hemostatic Dressing","code_information":[{"code":"CP17744631830073208","type":"CDM"},{"code":"250","type":"RC"},{"code":"18856","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":110,"maximum":137,"gross_charge":137,"discounted_cash":137,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":137},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluad Quad Pfs23-24 0.5ml Dose","code_information":[{"code":"CP17744631829960645","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461012303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":109,"maximum":136,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fluad Quadri Inj 2023-24","code_information":[{"code":"CP17744631829968915","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461012303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":109,"maximum":136,"gross_charge":136,"discounted_cash":136,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":136},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Epinephrine  Inj 0.3mg","code_information":[{"code":"CP17744631829797845","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502010202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":135,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Loteprednol  Sus 0.5%","code_information":[{"code":"CP17744631830375451","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682029905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":135,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Rollator Tall","code_information":[{"code":"CP17744631830910277","type":"CDM"},{"code":"250","type":"RC"},{"code":"71707608657","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":135,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mk Wheelchair 16 Dda Sf","code_information":[{"code":"CP17744631830496531","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922318","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":135,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wheelchair   Mis","code_information":[{"code":"CP17744631831378592","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703019152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":135,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wheelchair18\"","code_information":[{"code":"CP17744631831373317","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703019152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":135,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wheelchairssp218dda-sf","code_information":[{"code":"CP17744631831370718","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703019152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":108,"maximum":135,"gross_charge":135,"discounted_cash":135,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":135},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Complera     Tab","code_information":[{"code":"CP17744631829418152","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958110101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":134,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Odefsey      Tab","code_information":[{"code":"CP17744631830666119","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958210101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":134,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Odefsey 200-25-25mg Tabs","code_information":[{"code":"CP17744631830663001","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958210101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":134,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Triumeq      Tab","code_information":[{"code":"CP17744631831192363","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702023113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":134,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triumeq  Tabs","code_information":[{"code":"CP17744631831195473","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702023113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":107,"maximum":134,"gross_charge":134,"discounted_cash":134,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":134},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Deferiprone  Tab 1000mg","code_information":[{"code":"CP17744631829552500","type":"CDM"},{"code":"250","type":"RC"},{"code":"54071","type":"CPT","modifier":"119"}],"standard_charges":[{"setting":"outpatient","modifier_code":["119"],"minimum":106,"maximum":133,"gross_charge":133,"discounted_cash":133,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":133},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Austedo      Tab 12mg","code_information":[{"code":"CP17744631828799055","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546017260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":106,"maximum":132,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Austedo 12mg Tabs","code_information":[{"code":"CP17744631828790340","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546017260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":106,"maximum":132,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Spiriva      Aer 1.25mcg","code_information":[{"code":"CP17744631831055550","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":132,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Spiriva Resp 1.25mcg (60 Inh)","code_information":[{"code":"CP17744631831053848","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":132,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Spiriva Resp Aer 1.25mcg 60 In","code_information":[{"code":"CP17744631831050196","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106,"maximum":132,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ciprofloxacn Sol 0.2%","code_information":[{"code":"CP17744631829232794","type":"CDM"},{"code":"250","type":"RC"},{"code":"42195055014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":106,"maximum":132,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Ciprofloxcn Otic 0.2% Sol","code_information":[{"code":"CP17744631829245499","type":"CDM"},{"code":"250","type":"RC"},{"code":"42195055014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":106,"maximum":132,"gross_charge":132,"discounted_cash":132,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":132},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Erleada      Tab 60mg","code_information":[{"code":"CP17744631829791461","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676060012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":105,"maximum":131,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lidocaine/hc Kit 3%-0.5%","code_information":[{"code":"CP17744631830330302","type":"CDM"},{"code":"250","type":"RC"},{"code":"59088081920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":105,"maximum":131,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine/hydrocort 3-0.5% Crm","code_information":[{"code":"CP17744631830330292","type":"CDM"},{"code":"250","type":"RC"},{"code":"59088081920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":105,"maximum":131,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Imiquimod    Cre 5%","code_information":[{"code":"CP17744631830133988","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462053670","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":105,"maximum":131,"gross_charge":131,"discounted_cash":131,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":131},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Butrans      Dis 15mcg/hr","code_information":[{"code":"CP17744631829047217","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011075804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Iv Pole      Mis","code_information":[{"code":"CP17744631830179375","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601058600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/salme Aer 113/14 60inh","code_information":[{"code":"CP17744631829984698","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"882"}],"standard_charges":[{"setting":"outpatient","modifier_code":["882"],"minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":113,"type":"EA"}},{"description":"Flutic/salme Inh 113/14","code_information":[{"code":"CP17744631829984088","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"882"}],"standard_charges":[{"setting":"outpatient","modifier_code":["882"],"minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticas/salmet 113-14","code_information":[{"code":"CP17744631829987620","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"882"}],"standard_charges":[{"setting":"outpatient","modifier_code":["882"],"minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticasone Propionate 113/14","code_information":[{"code":"CP17744631829987491","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"882"}],"standard_charges":[{"setting":"outpatient","modifier_code":["882"],"minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Arnuity Ellipta 200mcg (14inh)","code_information":[{"code":"CP17744631828755050","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Arnuity Ellipta 200mcg (30inh)","code_information":[{"code":"CP17744631828757627","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Arnuity Ellipta 200mcg Inhaler","code_information":[{"code":"CP17744631828754640","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Arnuity Elpt Inh 200mcg","code_information":[{"code":"CP17744631828750752","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104,"maximum":130,"gross_charge":130,"discounted_cash":130,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":130},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dexcom G6    Mis Sensor","code_information":[{"code":"CP17744631829572025","type":"CDM"},{"code":"250","type":"RC"},{"code":"8627005303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":103,"maximum":129,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexcom G7    Mis Sensor","code_information":[{"code":"CP17744631829574832","type":"CDM"},{"code":"250","type":"RC"},{"code":"8627007701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":103,"maximum":129,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Invanz       Inj 1gm","code_information":[{"code":"CP17744631830150035","type":"CDM"},{"code":"250","type":"RC"},{"code":"63843","type":"CPT","modifier":"71"}],"standard_charges":[{"setting":"outpatient","modifier_code":["71"],"minimum":103,"maximum":129,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Everolimus   Tab 7.5mg","code_information":[{"code":"CP17744631829838221","type":"CDM"},{"code":"250","type":"RC"},{"code":"54049","type":"CPT","modifier":"714"}],"standard_charges":[{"setting":"outpatient","modifier_code":["714"],"minimum":103,"maximum":129,"gross_charge":129,"discounted_cash":129,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":129},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Bromfenac    Dro 0.07% Op","code_information":[{"code":"CP17744631828952341","type":"CDM"},{"code":"250","type":"RC"},{"code":"82260060203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":102,"maximum":128,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xtandi       Cap 40mg","code_information":[{"code":"CP17744631831383581","type":"CDM"},{"code":"250","type":"RC"},{"code":"46901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":128,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Xtandi       Tab 40mg","code_information":[{"code":"CP17744631831388861","type":"CDM"},{"code":"250","type":"RC"},{"code":"46906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102,"maximum":128,"gross_charge":128,"discounted_cash":128,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":128},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ilevro       Dro 0.3% Op","code_information":[{"code":"CP17744631830134435","type":"CDM"},{"code":"250","type":"RC"},{"code":"78074","type":"CPT","modifier":"303"}],"standard_charges":[{"setting":"outpatient","modifier_code":["303"],"minimum":102,"maximum":127,"gross_charge":127,"discounted_cash":127,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":127},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aplisol      Inj 5/0.1ml","code_information":[{"code":"CP17744631828731396","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Aplisol  0.5u/ 0.1ml (10 Test)","code_information":[{"code":"CP17744631828739903","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"Aplisol Muv 1ml 0.5t / 0.1ml","code_information":[{"code":"CP17744631828734319","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Tubersol     Inj 5/0.1ml","code_information":[{"code":"CP17744631831196601","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Tubersol  5u/0.1ml (10 Test)","code_information":[{"code":"CP17744631831193451","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"Tubersol (Mantoux) 10tests/vl","code_information":[{"code":"CP17744631831193238","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tubersol 10 Tests/vl","code_information":[{"code":"CP17744631831194305","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluad Quadri Inj 2022-23","code_information":[{"code":"CP17744631829965861","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461012203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":2022,"type":"EA"}},{"description":"Moviprep     Sol","code_information":[{"code":"CP17744631830512152","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649020175","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nubeqa       Tab 300mg","code_information":[{"code":"CP17744631830641928","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419039501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":101,"maximum":126,"gross_charge":126,"discounted_cash":126,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":126},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Juluca       Tab 50-25mg","code_information":[{"code":"CP17744631830185284","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702024213","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Juluca 50-25 Mg Tablet","code_information":[{"code":"CP17744631830182896","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702024213","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Rollator Bariatric","code_information":[{"code":"CP17744631830919897","type":"CDM"},{"code":"250","type":"RC"},{"code":"17076006072","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diazepam     Gel 2.5mg","code_information":[{"code":"CP17744631829586779","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"First-mouthw Sus Blm","code_information":[{"code":"CP17744631829955496","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628005001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Loteprednol  Gel 0.5%","code_information":[{"code":"CP17744631830378041","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Zimhi        Sol","code_information":[{"code":"CP17744631831398994","type":"CDM"},{"code":"250","type":"RC"},{"code":"78670014002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zimhi Sdv 5mg/ 0.5ml Dose","code_information":[{"code":"CP17744631831397881","type":"CDM"},{"code":"250","type":"RC"},{"code":"78670014002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Auvelity     Tab 45-105mg","code_information":[{"code":"CP17744631828795521","type":"CDM"},{"code":"250","type":"RC"},{"code":"81968004530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":100,"maximum":125,"gross_charge":125,"discounted_cash":125,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":125},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Eliquis      Tab 2.5mg","code_information":[{"code":"CP17744631829777343","type":"CDM"},{"code":"250","type":"RC"},{"code":"30893","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":99,"maximum":124,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Eliquis      Tab 5mg","code_information":[{"code":"CP17744631829773927","type":"CDM"},{"code":"250","type":"RC"},{"code":"30894","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":99,"maximum":124,"gross_charge":124,"discounted_cash":124,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":124},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831112463","type":"CDM"},{"code":"250","type":"RC"},{"code":"78126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":98,"maximum":122,"gross_charge":122,"discounted_cash":122,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":122},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Pyrimethamin Tab 25mg","code_information":[{"code":"CP17744631830854799","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598067230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Budesonide   Sus 1mg/2ml","code_information":[{"code":"CP17744631828966783","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335063349","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Jadenu Sprkl Gra 180mg","code_information":[{"code":"CP17744631830172966","type":"CDM"},{"code":"250","type":"RC"},{"code":"78071","type":"CPT","modifier":"315"}],"standard_charges":[{"setting":"outpatient","modifier_code":["315"],"minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Stiolto      Aer 2.5-2.5","code_information":[{"code":"CP17744631831068410","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Stiolto 2.5/2.5 (60 Inh/30day)","code_information":[{"code":"CP17744631831060939","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stiolto 2.5/2.5 (60)","code_information":[{"code":"CP17744631831064262","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stiolto Aer 2.5/2.5 60 Inh","code_information":[{"code":"CP17744631831065227","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Temozolomide Cap 20mg","code_information":[{"code":"CP17744631831112738","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729004954","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Glatiramer Acet 40mg/ml","code_information":[{"code":"CP17744631830034034","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Glatopa      Inj 40mg/ml","code_information":[{"code":"CP17744631830036706","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lantus Solos Inj 100/ml","code_information":[{"code":"CP17744631830222837","type":"CDM"},{"code":"250","type":"RC"},{"code":"88221","type":"CPT","modifier":"900"}],"standard_charges":[{"setting":"outpatient","modifier_code":["900"],"minimum":97,"maximum":121,"gross_charge":121,"discounted_cash":121,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":121},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Cresemba     Cap 186 Mg","code_information":[{"code":"CP17744631829435849","type":"CDM"},{"code":"250","type":"RC"},{"code":"46905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":119,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":186,"type":"ME"}},{"description":"Cresemba     Cap 186mg","code_information":[{"code":"CP17744631829439724","type":"CDM"},{"code":"250","type":"RC"},{"code":"46905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":119,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":186,"type":"ME"}},{"description":"Penciclovir  Cre 1%","code_information":[{"code":"CP17744631830744571","type":"CDM"},{"code":"250","type":"RC"},{"code":"37808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95,"maximum":119,"gross_charge":119,"discounted_cash":119,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":119},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Asmanex 60   Aer 220mcg","code_information":[{"code":"CP17744631828760089","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":94,"maximum":118,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Asmanex 60  Aer 220mcg (60inh)","code_information":[{"code":"CP17744631828763947","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":94,"maximum":118,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Anoro Ellipa 62.5-25 (7 Doses)","code_information":[{"code":"CP17744631828536260","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":118,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipt 62.5-25 (7 Inh)","code_information":[{"code":"CP17744631828536701","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":118,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipt 62.5-25 7 Inh","code_information":[{"code":"CP17744631828532307","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":118,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipt Aer 62.5-25","code_information":[{"code":"CP17744631828538374","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":94,"maximum":118,"gross_charge":118,"discounted_cash":118,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":118},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":625,"type":"EA"}},{"description":"Restasis Mul Emu 0.05%","code_information":[{"code":"CP17744631830894389","type":"CDM"},{"code":"250","type":"RC"},{"code":"23530","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":94,"maximum":117,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Restasis Mul Emu 0.05% Op","code_information":[{"code":"CP17744631830890345","type":"CDM"},{"code":"250","type":"RC"},{"code":"23530","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":94,"maximum":117,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pneumovax 23 25mcg/0.5ml Inj","code_information":[{"code":"CP17744631830783156","type":"CDM"},{"code":"250","type":"RC"},{"code":"64837","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":94,"maximum":117,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pneumovax 23 Inj 25/0.5","code_information":[{"code":"CP17744631830781053","type":"CDM"},{"code":"250","type":"RC"},{"code":"64837","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":94,"maximum":117,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Pneumovax23 Pfs 25/0.5ml Dose","code_information":[{"code":"CP17744631830780807","type":"CDM"},{"code":"250","type":"RC"},{"code":"64837","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":94,"maximum":117,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fluad Quad 2021/22 Syr 65+","code_information":[{"code":"CP17744631829965641","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461012103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":94,"maximum":117,"gross_charge":117,"discounted_cash":117,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":117},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Esbriet      Tab 801mg","code_information":[{"code":"CP17744631829811026","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242012301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":93,"maximum":116,"gross_charge":116,"discounted_cash":116,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":116},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93}]}],"drug_information":{"unit":801,"type":"ME"}},{"description":"Acyclovir    Oin 5%","code_information":[{"code":"CP17744631828332139","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":91,"maximum":114,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Etonogestrel Mis Ethy Est","code_information":[{"code":"CP17744631829826689","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993060536","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":91,"maximum":114,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ubrelvy      Tab 100mg","code_information":[{"code":"CP17744631831204634","type":"CDM"},{"code":"250","type":"RC"},{"code":"23650","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":91,"maximum":114,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ubrelvy      Tab 50mg","code_information":[{"code":"CP17744631831202258","type":"CDM"},{"code":"250","type":"RC"},{"code":"23649","type":"CPT","modifier":"810"}],"standard_charges":[{"setting":"outpatient","modifier_code":["810"],"minimum":91,"maximum":114,"gross_charge":114,"discounted_cash":114,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":114},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Retacrit     Inj 10000unt","code_information":[{"code":"CP17744631830890150","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"810"}],"standard_charges":[{"setting":"outpatient","modifier_code":["810"],"minimum":90,"maximum":113,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Retacrit     Inj 10000unt","code_information":[{"code":"CP17744631830890484","type":"CDM"},{"code":"250","type":"RC"},{"code":"69131","type":"CPT","modifier":"810"}],"standard_charges":[{"setting":"outpatient","modifier_code":["810"],"minimum":90,"maximum":113,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Retacrit-20000unit/2ml-soln","code_information":[{"code":"CP17744631830891689","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"810"}],"standard_charges":[{"setting":"outpatient","modifier_code":["810"],"minimum":90,"maximum":113,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":20000,"type":"UN"}},{"description":"Retacrit-20000unit/2ml-soln","code_information":[{"code":"CP17744631830898271","type":"CDM"},{"code":"250","type":"RC"},{"code":"69131","type":"CPT","modifier":"810"}],"standard_charges":[{"setting":"outpatient","modifier_code":["810"],"minimum":90,"maximum":113,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":20000,"type":"UN"}},{"description":"Adlarity     Dis 10mg/day","code_information":[{"code":"CP17744631828352701","type":"CDM"},{"code":"250","type":"RC"},{"code":"65038005603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":90,"maximum":113,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Adlarity     Dis 5mg/day","code_information":[{"code":"CP17744631828356271","type":"CDM"},{"code":"250","type":"RC"},{"code":"65038005503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":90,"maximum":113,"gross_charge":113,"discounted_cash":113,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":113},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Glatiramer   Inj 40mg/ml","code_information":[{"code":"CP17744631830036758","type":"CDM"},{"code":"250","type":"RC"},{"code":"37869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90,"maximum":112,"gross_charge":112,"discounted_cash":112,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":112},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fingolimod   Cap 0.5mg","code_information":[{"code":"CP17744631829956338","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980044903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":89,"maximum":111,"gross_charge":111,"discounted_cash":111,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":111},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pentamidine  Inh 300mg","code_information":[{"code":"CP17744631830747576","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925052201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":88,"maximum":110,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pentamidine  Inh 300mg Vial","code_information":[{"code":"CP17744631830744018","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925052201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":88,"maximum":110,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Fosamax + D  Tab 70-5600","code_information":[{"code":"CP17744631829992964","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206013601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":88,"maximum":110,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Nevanac      Sus 0.1% Op","code_information":[{"code":"CP17744631830556026","type":"CDM"},{"code":"250","type":"RC"},{"code":"78077","type":"CPT","modifier":"803"}],"standard_charges":[{"setting":"outpatient","modifier_code":["803"],"minimum":88,"maximum":110,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prednis 1/moxifl / Nepaf 0.1","code_information":[{"code":"CP17744631830817275","type":"CDM"},{"code":"250","type":"RC"},{"code":"78077","type":"CPT","modifier":"803"}],"standard_charges":[{"setting":"outpatient","modifier_code":["803"],"minimum":88,"maximum":110,"gross_charge":110,"discounted_cash":110,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":110},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Solu-medrol  Inj 2gm","code_information":[{"code":"CP17744631831059894","type":"CDM"},{"code":"250","type":"RC"},{"code":"90850","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":87,"maximum":109,"gross_charge":109,"discounted_cash":109,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":109},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Dovato       Tab 50-300mg","code_information":[{"code":"CP17744631829725722","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702024613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Injectafer   Inj 750/15ml","code_information":[{"code":"CP17744631830146229","type":"CDM"},{"code":"250","type":"RC"},{"code":"51706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Injectafer 750/15mlns 250ml","code_information":[{"code":"CP17744631830144983","type":"CDM"},{"code":"250","type":"RC"},{"code":"51706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Injectafer Inj 750mg/ns 250ml","code_information":[{"code":"CP17744631830148181","type":"CDM"},{"code":"250","type":"RC"},{"code":"51706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Buprenorphin Dis 15mcg/hr","code_information":[{"code":"CP17744631828973383","type":"CDM"},{"code":"250","type":"RC"},{"code":"93365","type":"CPT","modifier":"840"}],"standard_charges":[{"setting":"outpatient","modifier_code":["840"],"minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Temozolomide Cap 250mg","code_information":[{"code":"CP17744631831113525","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080651","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Temozolomide Cap 250mg","code_information":[{"code":"CP17744631831118863","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Lumigan      Sol 0.01%","code_information":[{"code":"CP17744631830387572","type":"CDM"},{"code":"250","type":"RC"},{"code":"23320","type":"CPT","modifier":"508"}],"standard_charges":[{"setting":"outpatient","modifier_code":["508"],"minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lumigan      Sol 0.01% Op","code_information":[{"code":"CP17744631830382684","type":"CDM"},{"code":"250","type":"RC"},{"code":"23320","type":"CPT","modifier":"508"}],"standard_charges":[{"setting":"outpatient","modifier_code":["508"],"minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inveltys     Sus 1%","code_information":[{"code":"CP17744631830154701","type":"CDM"},{"code":"250","type":"RC"},{"code":"71571012128","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":108,"gross_charge":108,"discounted_cash":108,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":108},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Myrbetriq    Tab 50mg","code_information":[{"code":"CP17744631830537927","type":"CDM"},{"code":"250","type":"RC"},{"code":"46926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Epinephrine  Inj 0.15mg","code_information":[{"code":"CP17744631829791413","type":"CDM"},{"code":"250","type":"RC"},{"code":"11516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Flutic/salme Aer 55/14 60inh","code_information":[{"code":"CP17744631829983435","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"782"}],"standard_charges":[{"setting":"outpatient","modifier_code":["782"],"minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":55,"type":"EA"}},{"description":"Flutic/salme Inh 55/14","code_information":[{"code":"CP17744631829982215","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"782"}],"standard_charges":[{"setting":"outpatient","modifier_code":["782"],"minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticasone/salmeterol 55-14","code_information":[{"code":"CP17744631829981072","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"782"}],"standard_charges":[{"setting":"outpatient","modifier_code":["782"],"minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Procrit      Inj 4000/ml","code_information":[{"code":"CP17744631830831668","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676030401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":4000,"type":"EA"}},{"description":"Vyzulta      Sol 0.024%","code_information":[{"code":"CP17744631831306486","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":24,"type":"EA"}},{"description":"Arzol Silver Mis Nitr App","code_information":[{"code":"CP17744631828751137","type":"CDM"},{"code":"250","type":"RC"},{"code":"12870000102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Arzol Silver Nitrate App","code_information":[{"code":"CP17744631828751013","type":"CDM"},{"code":"250","type":"RC"},{"code":"12870000102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":86,"maximum":107,"gross_charge":107,"discounted_cash":107,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":107},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wellbutrin   Tab Xl 300mg","code_information":[{"code":"CP17744631831370555","type":"CDM"},{"code":"250","type":"RC"},{"code":"18707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85,"maximum":106,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Wheelchair 18\" Fa Sf","code_information":[{"code":"CP17744631831371137","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":85,"maximum":106,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Capecitabine 500mg Tabs","code_information":[{"code":"CP17744631829107905","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000792","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":85,"maximum":106,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829105272","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000792","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":85,"maximum":106,"gross_charge":106,"discounted_cash":106,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":106},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Milrinone/d5 Inj 40/200ml","code_information":[{"code":"CP17744631830486481","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":105,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}],"drug_information":{"unit":200,"type":"ML"}},{"description":"Fosaprepitan Sol 150mg","code_information":[{"code":"CP17744631829993098","type":"CDM"},{"code":"250","type":"RC"},{"code":"59143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":105,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Sucralfate   Sus 1gm/10ml","code_information":[{"code":"CP17744631831074440","type":"CDM"},{"code":"250","type":"RC"},{"code":"12109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":84,"maximum":105,"gross_charge":105,"discounted_cash":105,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":105},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Nevanac      Sus 0.1%","code_information":[{"code":"CP17744631830551141","type":"CDM"},{"code":"250","type":"RC"},{"code":"65000","type":"CPT","modifier":"203"}],"standard_charges":[{"setting":"outpatient","modifier_code":["203"],"minimum":83,"maximum":104,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin   Sol 50mg/ml","code_information":[{"code":"CP17744631831234531","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536010605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":83,"maximum":104,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lotemax      Oin 0.5%","code_information":[{"code":"CP17744631830371309","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208044335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":83,"maximum":104,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Flutic/salme Aer 232/14 60inh","code_information":[{"code":"CP17744631829980995","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"982"}],"standard_charges":[{"setting":"outpatient","modifier_code":["982"],"minimum":83,"maximum":104,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":232,"type":"EA"}},{"description":"Flutic/salme Inh 232/14","code_information":[{"code":"CP17744631829987492","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"982"}],"standard_charges":[{"setting":"outpatient","modifier_code":["982"],"minimum":83,"maximum":104,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticasone Prop 232/14mcg","code_information":[{"code":"CP17744631829988992","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"982"}],"standard_charges":[{"setting":"outpatient","modifier_code":["982"],"minimum":83,"maximum":104,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":232,"type":"ME"}},{"description":"Fluticasone/salmeterol 232-14","code_information":[{"code":"CP17744631829989309","type":"CDM"},{"code":"250","type":"RC"},{"code":"93360","type":"CPT","modifier":"982"}],"standard_charges":[{"setting":"outpatient","modifier_code":["982"],"minimum":83,"maximum":104,"gross_charge":104,"discounted_cash":104,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":104},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azasite      Sol 1%","code_information":[{"code":"CP17744631828800582","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584030703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":103,"gross_charge":103,"discounted_cash":103,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":103},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adacel       Inj","code_information":[{"code":"CP17744631828341150","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281040020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":102,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adacel Pfs 2-2.5-5/0.5ml Dose","code_information":[{"code":"CP17744631828343796","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281040020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":102,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Otezla       Tab 10/20/30","code_information":[{"code":"CP17744631830691247","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513036955","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":82,"maximum":102,"gross_charge":102,"discounted_cash":102,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":102},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Cresemba     Cap 186 Mg","code_information":[{"code":"CP17744631829432509","type":"CDM"},{"code":"250","type":"RC"},{"code":"46905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81,"maximum":101,"gross_charge":101,"discounted_cash":101,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":101},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81}]}],"drug_information":{"unit":186,"type":"ME"}},{"description":"Boostrix     Inj","code_information":[{"code":"CP17744631828946056","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Boostrix     Inj","code_information":[{"code":"CP17744631828942919","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160084211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Boostrix Tdap Sdv 0.5ml Dose","code_information":[{"code":"CP17744631828947640","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160084211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Dorzol/timol 2/.5% Os Pf Bp","code_information":[{"code":"CP17744631829720948","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862094760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dorzol/timol 2/.5% Pf Pack 60","code_information":[{"code":"CP17744631829724850","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862094760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 2%-0.5%","code_information":[{"code":"CP17744631829724694","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862094760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 2%-0.5%  Pf","code_information":[{"code":"CP17744631829722140","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862094760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829728445","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862094760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Tigecycline 50mg/100ml Ns 0.9%","code_information":[{"code":"CP17744631831133212","type":"CDM"},{"code":"250","type":"RC"},{"code":"84990","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tygacil      Inj 50mg","code_information":[{"code":"CP17744631831205858","type":"CDM"},{"code":"250","type":"RC"},{"code":"84990","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":80,"maximum":100,"gross_charge":100,"discounted_cash":100,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":100},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Austedo      Tab 9mg","code_information":[{"code":"CP17744631828794195","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546017160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":79,"maximum":99,"gross_charge":99,"discounted_cash":99,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":99},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Travatan Z   Dro 0.004%","code_information":[{"code":"CP17744631831166289","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758009556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Travatan Z   Dro 0.004%","code_information":[{"code":"CP17744631831165201","type":"CDM"},{"code":"250","type":"RC"},{"code":"78094","type":"CPT","modifier":"640"}],"standard_charges":[{"setting":"outpatient","modifier_code":["640"],"minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aplisol      Inj 5/0.1ml","code_information":[{"code":"CP17744631828731613","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Aplisol  0.5u/ 0.1ml (50 Test)","code_information":[{"code":"CP17744631828733781","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"Aplisol Muv 5ml 0.5t / 0.1ml","code_information":[{"code":"CP17744631828731924","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023010405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tubersol     Inj 5/0.1ml","code_information":[{"code":"CP17744631831196598","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Tubersol  5u/0.1ml (50 Test)","code_information":[{"code":"CP17744631831198256","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281075222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":5,"type":"UN"}},{"description":"M-m-r Ii Sdv =1","code_information":[{"code":"CP17744631830491819","type":"CDM"},{"code":"250","type":"RC"},{"code":"64681","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Priorix      Inj","code_information":[{"code":"CP17744631830838365","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zomig        Spr 5mg","code_information":[{"code":"CP17744631831416472","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896068151","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Daptomy/nacl Inj 500/50ml","code_information":[{"code":"CP17744631829482926","type":"CDM"},{"code":"250","type":"RC"},{"code":"33807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":98,"gross_charge":98,"discounted_cash":98,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":98},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Arnuity Elpt  100mcg (14 Inh)","code_information":[{"code":"CP17744631828756945","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":97,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Arnuity Elpt 100mcg (30 Inh)","code_information":[{"code":"CP17744631828755577","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":97,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Arnuity Elpt Inh 100mcg","code_information":[{"code":"CP17744631828752448","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78,"maximum":97,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nitazoxanide Tab 500mg","code_information":[{"code":"CP17744631830563339","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980052660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":78,"maximum":97,"gross_charge":97,"discounted_cash":97,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":97},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Genotropin   Inj 0.6mg","code_information":[{"code":"CP17744631830028153","type":"CDM"},{"code":"250","type":"RC"},{"code":"13265","type":"CPT","modifier":"102"}],"standard_charges":[{"setting":"outpatient","modifier_code":["102"],"minimum":77,"maximum":96,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Humulin R    Inj U-500","code_information":[{"code":"CP17744631830096052","type":"CDM"},{"code":"250","type":"RC"},{"code":"28824","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":77,"maximum":96,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Humulin R U-500 Kwikpen","code_information":[{"code":"CP17744631830092389","type":"CDM"},{"code":"250","type":"RC"},{"code":"28824","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":77,"maximum":96,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Humulin R U-500 Pen 3ml","code_information":[{"code":"CP17744631830096072","type":"CDM"},{"code":"250","type":"RC"},{"code":"28824","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":77,"maximum":96,"gross_charge":96,"discounted_cash":96,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":96},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Lyumjev 100 Unit/ Ml Kwpen 3ml","code_information":[{"code":"CP17744631830394033","type":"CDM"},{"code":"250","type":"RC"},{"code":"28207","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Lyumjev Kwpn Inj 100ut/ml","code_information":[{"code":"CP17744631830394267","type":"CDM"},{"code":"250","type":"RC"},{"code":"28207","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Zirgan       Gel 0.15%","code_information":[{"code":"CP17744631831404611","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208053535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Toujeo Max   Inj 300iu/ml","code_information":[{"code":"CP17744631831151956","type":"CDM"},{"code":"250","type":"RC"},{"code":"24587","type":"CPT","modifier":"102"}],"standard_charges":[{"setting":"outpatient","modifier_code":["102"],"minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":300,"type":"F2"}},{"description":"Toujeo Max 300 Units/ml 3 Ml","code_information":[{"code":"CP17744631831157120","type":"CDM"},{"code":"250","type":"RC"},{"code":"24587","type":"CPT","modifier":"102"}],"standard_charges":[{"setting":"outpatient","modifier_code":["102"],"minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":300,"type":"UN"}},{"description":"Olumiant     Tab 2mg","code_information":[{"code":"CP17744631830672865","type":"CDM"},{"code":"250","type":"RC"},{"code":"24182","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tpn Iv (<2000ml Bag)","code_information":[{"code":"CP17744631831154763","type":"CDM"},{"code":"250","type":"RC"},{"code":"17191000740","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":2000,"type":"ML"}},{"description":"Orgovyx      Tab 120mg","code_information":[{"code":"CP17744631830695829","type":"CDM"},{"code":"250","type":"RC"},{"code":"72974012001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":76,"maximum":95,"gross_charge":95,"discounted_cash":95,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":95},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Emergency Edk","code_information":[{"code":"CP17744631829771466","type":"CDM"},{"code":"250","type":"RC"},{"code":"11516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epinephrine  Inj 0.3mg","code_information":[{"code":"CP17744631829797113","type":"CDM"},{"code":"250","type":"RC"},{"code":"11516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Drainage Catheter Pleurx","code_information":[{"code":"CP17744631829743869","type":"CDM"},{"code":"250","type":"RC"},{"code":"47615","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"After Hours","code_information":[{"code":"CP17744631828375274","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999154635","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Linezolid    Inj 2mg/ml","code_information":[{"code":"CP17744631830347304","type":"CDM"},{"code":"250","type":"RC"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Linezolid 600mg/300ml","code_information":[{"code":"CP17744631830349210","type":"CDM"},{"code":"250","type":"RC"},{"code":"66794021943","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Tobradex     Oin 0.3-0.1%","code_information":[{"code":"CP17744631831146438","type":"CDM"},{"code":"250","type":"RC"},{"code":"78087","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Imitrex      Spr 20mg/act","code_information":[{"code":"CP17744631830135805","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Imitrex      Spr 5mg/act","code_information":[{"code":"CP17744631830134044","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rifampin     Inj 600 Mg","code_information":[{"code":"CP17744631830895246","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323035120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":75,"maximum":94,"gross_charge":94,"discounted_cash":94,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":94},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Otezla       Tab 30mg","code_information":[{"code":"CP17744631830697089","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513013760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":93,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Asmanex 30   Aer 110mcg","code_information":[{"code":"CP17744631828761682","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":93,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":11,"type":"ME"}},{"description":"Asmanex 30  Aer 110mcg (30inh)","code_information":[{"code":"CP17744631828769542","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":93,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":11,"type":"ME"}},{"description":"Reyvow       Tab 100mg","code_information":[{"code":"CP17744631830896975","type":"CDM"},{"code":"250","type":"RC"},{"code":"24491","type":"CPT","modifier":"8"}],"standard_charges":[{"setting":"outpatient","modifier_code":["8"],"minimum":74,"maximum":93,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cyclosporine Emu 0.05%","code_information":[{"code":"CP17744631829442232","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505620201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":93,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Emu 0.05% Op","code_information":[{"code":"CP17744631829440266","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505620201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":93,"gross_charge":93,"discounted_cash":93,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":93},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluzone Hd   Inj 2023-24","code_information":[{"code":"CP17744631829996941","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012365","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Fluzone High-dose Pfs 2023","code_information":[{"code":"CP17744631829990238","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012365","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluzonehd Pfs 23-24 0.7ml Dose","code_information":[{"code":"CP17744631829992218","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012365","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":7,"type":"ML"}},{"description":"Rayos        Tab 2mg","code_information":[{"code":"CP17744631830877285","type":"CDM"},{"code":"250","type":"RC"},{"code":"75987002101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tenivac      Inj 5-2lf","code_information":[{"code":"CP17744631831119069","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281021510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Tenivac      Inj 5-2lf","code_information":[{"code":"CP17744631831111592","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Tenivac Tet Dip Pfs 0.5ml Dose","code_information":[{"code":"CP17744631831119173","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tenivac Tet Dip Sdv 0.5ml Dose","code_information":[{"code":"CP17744631831117155","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281021510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":74,"maximum":92,"gross_charge":92,"discounted_cash":92,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":92},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fondaparinux Inj 7.5/0.6","code_information":[{"code":"CP17744631829999866","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Monurol      Pak Granules","code_information":[{"code":"CP17744631830506989","type":"CDM"},{"code":"250","type":"RC"},{"code":"45643","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Monurol 3gm Packet","code_information":[{"code":"CP17744631830505826","type":"CDM"},{"code":"250","type":"RC"},{"code":"45643","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828748195","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097016887","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828748834","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748017530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Everolimus   Tab 10mg","code_information":[{"code":"CP17744631829834047","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991082428","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Everolimus   Tab 5mg","code_information":[{"code":"CP17744631829834774","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991082233","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Regranex 0.01% Gel","code_information":[{"code":"CP17744631830886478","type":"CDM"},{"code":"250","type":"RC"},{"code":"50484081015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":73,"maximum":91,"gross_charge":91,"discounted_cash":91,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":91},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Deferiprone  Tab 1000mg","code_information":[{"code":"CP17744631829559156","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672423704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"First-mouthw Sus Blm","code_information":[{"code":"CP17744631829953699","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628005004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proair Digih Aer","code_information":[{"code":"CP17744631830831640","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310011720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proair Digih Aer 200 Inh","code_information":[{"code":"CP17744631830830746","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310011720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Saxenda      Inj 18mg/3ml","code_information":[{"code":"CP17744631830998115","type":"CDM"},{"code":"250","type":"RC"},{"code":"16928","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Saxenda 18mg/3ml Inj","code_information":[{"code":"CP17744631830997460","type":"CDM"},{"code":"250","type":"RC"},{"code":"16928","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Autoshield   Mis 30gx5mm","code_information":[{"code":"CP17744631828791183","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290329515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Autoshield 30gx3/16\" Bd Pentip","code_information":[{"code":"CP17744631828796852","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290329515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":30,"type":"EA"}},{"description":"Safety Pen Ndl (Autoshild) 30g","code_information":[{"code":"CP17744631830929016","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290329515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":30,"type":"GR"}},{"description":"Havrix       Inj 1440unit","code_information":[{"code":"CP17744631830073857","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1440,"type":"UN"}},{"description":"Havrix Pfs 1440unit 1ml Dose","code_information":[{"code":"CP17744631830073879","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":72,"maximum":90,"gross_charge":90,"discounted_cash":90,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":90},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72}]}],"drug_information":{"unit":1440,"type":"UN"}},{"description":"Azasite      Sol 1%","code_information":[{"code":"CP17744631828809580","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478030703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":71,"maximum":89,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/salme Aer 500/50","code_information":[{"code":"CP17744631829983785","type":"CDM"},{"code":"250","type":"RC"},{"code":"54032","type":"CPT","modifier":"856"}],"standard_charges":[{"setting":"outpatient","modifier_code":["856"],"minimum":71,"maximum":89,"gross_charge":89,"discounted_cash":89,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":89},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828953810","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":88,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Austedo      Tab 6mg","code_information":[{"code":"CP17744631828790992","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546017060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":88,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Austedo Xr   Tab 6mg","code_information":[{"code":"CP17744631828791872","type":"CDM"},{"code":"250","type":"RC"},{"code":"68546047056","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":88,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Tobrex       Oin 0.3% Op","code_information":[{"code":"CP17744631831147647","type":"CDM"},{"code":"250","type":"RC"},{"code":"78081","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":70,"maximum":88,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Fentanyl     Dis 87.5mcg","code_information":[{"code":"CP17744631829850904","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70,"maximum":88,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Fluzone Hd   Inj 2022-23","code_information":[{"code":"CP17744631829994519","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012265","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":88,"gross_charge":88,"discounted_cash":88,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":88},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":2022,"type":"EA"}},{"description":"Oxacillin    Inj 2gm","code_information":[{"code":"CP17744631830708365","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":87,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Epinephrine  Kit 1mg/ml","code_information":[{"code":"CP17744631829792605","type":"CDM"},{"code":"250","type":"RC"},{"code":"71923010020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":87,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Epinephrine  Kit Snap-ems","code_information":[{"code":"CP17744631829793271","type":"CDM"},{"code":"250","type":"RC"},{"code":"71923010020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":70,"maximum":87,"gross_charge":87,"discounted_cash":87,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":87},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancocin Hcl Cap 125mg","code_information":[{"code":"CP17744631831238895","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559031020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":69,"maximum":86,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Sumatriptan  Inj 6mg/0.5","code_information":[{"code":"CP17744631831088650","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335027641","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":69,"maximum":86,"gross_charge":86,"discounted_cash":86,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":86},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Elastic Tubular Bandage","code_information":[{"code":"CP17744631829765894","type":"CDM"},{"code":"250","type":"RC"},{"code":"18213","type":"CPT","modifier":"112"}],"standard_charges":[{"setting":"outpatient","modifier_code":["112"],"minimum":68,"maximum":85,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Northera     Cap 200mg","code_information":[{"code":"CP17744631830576291","type":"CDM"},{"code":"250","type":"RC"},{"code":"67386082119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":68,"maximum":85,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Aprepitant   Pak 80 & 125","code_information":[{"code":"CP17744631828733982","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462011233","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":68,"maximum":85,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tolvaptan    Tab 15mg","code_information":[{"code":"CP17744631831155077","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505431700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":68,"maximum":85,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Xeljanz      Tab 5mg","code_information":[{"code":"CP17744631831389964","type":"CDM"},{"code":"250","type":"RC"},{"code":"69100","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":68,"maximum":85,"gross_charge":85,"discounted_cash":85,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":85},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tolvaptan    Tab 15mg","code_information":[{"code":"CP17744631831152661","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884076854","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Tolvaptan    Tab 15mg","code_information":[{"code":"CP17744631831155197","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205013011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Tolvaptan    Tab 15mg","code_information":[{"code":"CP17744631831157526","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722086803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Cefazol/dex  Sol 2gm","code_information":[{"code":"CP17744631829149843","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazol/dex Sol 2gm","code_information":[{"code":"CP17744631829142708","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/50ml Dex","code_information":[{"code":"CP17744631829157767","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Vaqta        Inj 50unt/ml","code_information":[{"code":"CP17744631831244198","type":"CDM"},{"code":"250","type":"RC"},{"code":"64096","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Vaqta 50 Units/ Ml Pfs = 1","code_information":[{"code":"CP17744631831244010","type":"CDM"},{"code":"250","type":"RC"},{"code":"64096","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":50,"type":"UN"}},{"description":"Baxdela      Tab 450mg","code_information":[{"code":"CP17744631828848631","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":67,"maximum":84,"gross_charge":84,"discounted_cash":84,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":84},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Istalol      Sol 0.5% Op","code_information":[{"code":"CP17744631830166594","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208000401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":83,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Zolmitriptan Spr 2.5mg","code_information":[{"code":"CP17744631831401651","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238200606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":83,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tyrvaya      Sol 0.03mg","code_information":[{"code":"CP17744631831202882","type":"CDM"},{"code":"250","type":"RC"},{"code":"73521003002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":83,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Buprenorphin Dis 7.5/hr","code_information":[{"code":"CP17744631828985686","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858035340","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":83,"gross_charge":83,"discounted_cash":83,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":83},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humalog      Inj 100/ml","code_information":[{"code":"CP17744631830088417","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humalog 100 Units/ Ml Mdv 3ml","code_information":[{"code":"CP17744631830088880","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog 100unit/ml Vial","code_information":[{"code":"CP17744631830080727","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog Inj 100/ml 3ml Vial","code_information":[{"code":"CP17744631830089729","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Fluzone      Inj 2021-22","code_information":[{"code":"CP17744631829990903","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012165","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":2021,"type":"EA"}},{"description":"Fluzone Hd   Inj 2021-22","code_information":[{"code":"CP17744631829990645","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012165","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":2021,"type":"EA"}},{"description":"Fluzone Hd Pf 2021/2022","code_information":[{"code":"CP17744631829993518","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012165","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Free Libre3  Kit Plus/sen","code_information":[{"code":"CP17744631829999792","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599084400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromfenac    Sol 0.09% Op","code_information":[{"code":"CP17744631828952126","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332050817","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Xarelto      Tab 15mg","code_information":[{"code":"CP17744631831386582","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":66,"maximum":82,"gross_charge":82,"discounted_cash":82,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":82},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Semglee      Inj 100u/ml","code_information":[{"code":"CP17744631831003912","type":"CDM"},{"code":"250","type":"RC"},{"code":"83257001233","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":65,"maximum":81,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Miconazole 3 200mg Vag Sup","code_information":[{"code":"CP17744631830474313","type":"CDM"},{"code":"250","type":"RC"},{"code":"47217","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65,"maximum":81,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Sensipar 90mg Tabs","code_information":[{"code":"CP17744631831005922","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513007530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":65,"maximum":81,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Havrix Pfs 720unit  0.5ml Dose","code_information":[{"code":"CP17744631830079772","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082552","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":65,"maximum":81,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":720,"type":"UN"}},{"description":"Pentamidine  Inh 300mg","code_information":[{"code":"CP17744631830744203","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822303002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":65,"maximum":81,"gross_charge":81,"discounted_cash":81,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":81},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Wellbutrin   Tab Xl 150mg","code_information":[{"code":"CP17744631831379397","type":"CDM"},{"code":"250","type":"RC"},{"code":"18707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":80,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Wellbutrin Xl 150mg Tabs","code_information":[{"code":"CP17744631831377187","type":"CDM"},{"code":"250","type":"RC"},{"code":"18707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64,"maximum":80,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Silent Knigt Pill Crusher","code_information":[{"code":"CP17744631831011975","type":"CDM"},{"code":"250","type":"RC"},{"code":"5000000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":64,"maximum":80,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Procrit      Inj 3000/ml","code_information":[{"code":"CP17744631830839312","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676030301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":64,"maximum":80,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":3000,"type":"EA"}},{"description":"Rifampin     Inj 600 Mg","code_information":[{"code":"CP17744631830894017","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457044560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":64,"maximum":80,"gross_charge":80,"discounted_cash":80,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":80},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Creon        Cap 36000unt","code_information":[{"code":"CP17744631829429579","type":"CDM"},{"code":"250","type":"RC"},{"code":"32301","type":"CPT","modifier":"613"}],"standard_charges":[{"setting":"outpatient","modifier_code":["613"],"minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":36000,"type":"EA"}},{"description":"Creon 36000 Iu Caps","code_information":[{"code":"CP17744631829430726","type":"CDM"},{"code":"250","type":"RC"},{"code":"32301","type":"CPT","modifier":"613"}],"standard_charges":[{"setting":"outpatient","modifier_code":["613"],"minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":36000,"type":"F2"}},{"description":"Imiquimod    Cre 3.75%pmp","code_information":[{"code":"CP17744631830133497","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682027275","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Opipza       Mis 10mg","code_information":[{"code":"CP17744631830693092","type":"CDM"},{"code":"250","type":"RC"},{"code":"15370040330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lidocaine/hc Kit 3-2.5%","code_information":[{"code":"CP17744631830331534","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925016420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Micafungin 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830470593","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505612000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Emsam        Dis 12mg/24h","code_information":[{"code":"CP17744631829778579","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502090230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Emsam        Dis 6mg/24hr","code_information":[{"code":"CP17744631829779617","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502090030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Emsam 6mg/24hr Patch","code_information":[{"code":"CP17744631829779699","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502090030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Glatopa      Inj 40mg/ml","code_information":[{"code":"CP17744631830038693","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63,"maximum":79,"gross_charge":79,"discounted_cash":79,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":79},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Liraglutide  Inj 18mg/3ml","code_information":[{"code":"CP17744631830340983","type":"CDM"},{"code":"250","type":"RC"},{"code":"48036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":78,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Vancomycin   Inj 750mg","code_information":[{"code":"CP17744631831233396","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":78,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Temozolomide Cap 180mg","code_information":[{"code":"CP17744631831119529","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729013054","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":78,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Temozolomide Cap 180mg","code_information":[{"code":"CP17744631831113369","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571082041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":78,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Temozolomide Cap 180mg","code_information":[{"code":"CP17744631831115391","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080514","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":78,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Temozolomide Cap 180mg","code_information":[{"code":"CP17744631831118545","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571082051","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":78,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Ciloxan      Oin 0.3% Op","code_information":[{"code":"CP17744631829221249","type":"CDM"},{"code":"250","type":"RC"},{"code":"78084","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":62,"maximum":78,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":78},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Occupational Therapy","code_information":[{"code":"CP17744631657077400","type":"CDM"},{"code":"430","type":"RC"},{"code":"97165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":111,"gross_charge":78,"discounted_cash":78,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Fentanyl     Dis 62.5mcg","code_information":[{"code":"CP17744631829858911","type":"CDM"},{"code":"250","type":"RC"},{"code":"40690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Fentanyl     Dis 62.5mcg","code_information":[{"code":"CP17744631829859616","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Novofine Aut Mis 30gx8mm","code_information":[{"code":"CP17744631830574778","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Safety Pen Ndl (Novofine) 30g","code_information":[{"code":"CP17744631830923939","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":30,"type":"GR"}},{"description":"Zenpep       Cap 20000unt","code_information":[{"code":"CP17744631831390122","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":20000,"type":"EA"}},{"description":"Dihydroergot Spr 4mg/ml","code_information":[{"code":"CP17744631829600982","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682035710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Butrans      Dis 10mcg/hr","code_information":[{"code":"CP17744631829042164","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011075104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Butrans 10mcg/hr Patch","code_information":[{"code":"CP17744631829049854","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011075104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Janumet Xr   Tab 50-500mg","code_information":[{"code":"CP17744631830179002","type":"CDM"},{"code":"250","type":"RC"},{"code":"60078","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Janumet Xr 50-500mg Tb24","code_information":[{"code":"CP17744631830178936","type":"CDM"},{"code":"250","type":"RC"},{"code":"60078","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":62,"maximum":77,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":77},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Physical Therapy","code_information":[{"code":"CP17744631657085408","type":"CDM"},{"code":"420","type":"RC"},{"code":"97161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62,"maximum":111,"gross_charge":77,"discounted_cash":77,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":111},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Blue Cross Blue Shield","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":102},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62}]}]},{"description":"Freesty Libr Kit 2 Sensor","code_information":[{"code":"CP17744631829998721","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599080000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freesty Libr Kit 3 Sensor","code_information":[{"code":"CP17744631830004704","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599081800","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freesty Libr Kit Sensor","code_information":[{"code":"CP17744631830000923","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle    Kit Sensor","code_information":[{"code":"CP17744631830004660","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle Libre 14 Day","code_information":[{"code":"CP17744631830006748","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle Libre 14 Day Sensor","code_information":[{"code":"CP17744631830004081","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle Libre 2/sensor","code_information":[{"code":"CP17744631830008997","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599080000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Libre-2 Freestyle Sensor","code_information":[{"code":"CP17744631830327328","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599080000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle    Tes Lite","code_information":[{"code":"CP17744631830008903","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073070822","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Imitrex      Tab 100mg","code_information":[{"code":"CP17744631830138860","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Trexall      Tab 15mg","code_information":[{"code":"CP17744631831179480","type":"CDM"},{"code":"250","type":"RC"},{"code":"51285036901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Briviact     Tab 50mg","code_information":[{"code":"CP17744631828951844","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474057066","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Briviact 50mg Tabs","code_information":[{"code":"CP17744631828957848","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474057066","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Triple Helix Pow Collagen","code_information":[{"code":"CP17744631831194097","type":"CDM"},{"code":"250","type":"RC"},{"code":"66977031001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":61,"maximum":76,"gross_charge":76,"discounted_cash":76,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":76},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Temozolomide Cap 180mg","code_information":[{"code":"CP17744631831113646","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mysoline     Tab 250mg","code_information":[{"code":"CP17744631830531725","type":"CDM"},{"code":"250","type":"RC"},{"code":"66490069110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Engerix-b    Inj 20mcg/ml","code_information":[{"code":"CP17744631829779154","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Engerix-b    Inj 20mcg/ml","code_information":[{"code":"CP17744631829778388","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Engerix-b 20 Mcg/ml Pfs=1","code_information":[{"code":"CP17744631829786716","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Engerix-b Sdv 20mcg/ 1ml Dose","code_information":[{"code":"CP17744631829788412","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Incruse Ellipta-62.5mcg (7)","code_information":[{"code":"CP17744631830136364","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Incruse Elpt Inh 62.5mcg","code_information":[{"code":"CP17744631830138914","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Incruse Elpt Inh 62.5mcg 7 Inh","code_information":[{"code":"CP17744631830139315","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Fosfomycin   Pow 3gm","code_information":[{"code":"CP17744631829990804","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700026894","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Binosto      Tab 70mg","code_information":[{"code":"CP17744631828883005","type":"CDM"},{"code":"250","type":"RC"},{"code":"17139040004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Reditrex     Inj 25mg/ml","code_information":[{"code":"CP17744631830882679","type":"CDM"},{"code":"250","type":"RC"},{"code":"66220082522","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Stiolto      Aer 2.5-2.5","code_information":[{"code":"CP17744631831062900","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Stiolto 2.5-2.5 (10inh/5day)","code_information":[{"code":"CP17744631831061067","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stiolto Aer 2.5/2.5 10 Inh","code_information":[{"code":"CP17744631831067918","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Stiolto Are 2.5-2.5 (Sm)","code_information":[{"code":"CP17744631831068837","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tpn Iv (<1000ml Bag)","code_information":[{"code":"CP17744631831156708","type":"CDM"},{"code":"250","type":"RC"},{"code":"98006986759","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Jobst Ult/m Th-hi Sn Lg1","code_information":[{"code":"CP17744631830182287","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566422280","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":60,"maximum":75,"gross_charge":75,"discounted_cash":75,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":75},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levothyroxin Inj 100mcg","code_information":[{"code":"CP17744631830319219","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860045110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":59,"maximum":74,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Asmanex 14   Aer 220mcg","code_information":[{"code":"CP17744631828765101","type":"CDM"},{"code":"250","type":"RC"},{"code":"85134","type":"CPT","modifier":"106"}],"standard_charges":[{"setting":"outpatient","modifier_code":["106"],"minimum":59,"maximum":74,"gross_charge":74,"discounted_cash":74,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":74},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Descovy      Tab 200/25","code_information":[{"code":"CP17744631829567247","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958200201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Descovy      Tab 200/25mg","code_information":[{"code":"CP17744631829563135","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958200201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Descovy      Tab 200/25mg","code_information":[{"code":"CP17744631829566662","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958200202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Descovy 200-25mg Tabs","code_information":[{"code":"CP17744631829566648","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958200201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fluad        Inj 2024-25","code_information":[{"code":"CP17744631829961449","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461002403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Fluad Pfs 24-25 0.5ml Dose","code_information":[{"code":"CP17744631829969057","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461002403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Xerava 90mg/250ml El-m","code_information":[{"code":"CP17744631831382952","type":"CDM"},{"code":"250","type":"RC"},{"code":"71773005005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Mesalamine   Tab 800mg Dr","code_information":[{"code":"CP17744631830435148","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382043528","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Latuda       Tab 120mg","code_information":[{"code":"CP17744631830221904","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402031230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Catapres-tts 0.1mg/24hr Patch","code_information":[{"code":"CP17744631829142962","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Catapres-tts Dis 0.1/24hr","code_information":[{"code":"CP17744631829148159","type":"CDM"},{"code":"250","type":"RC"},{"code":"82089010134","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":73,"gross_charge":73,"discounted_cash":73,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":73},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Teriflunomid Tab 14mg","code_information":[{"code":"CP17744631831111541","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332031430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":72,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Recombiva Hb Inj 10mcg/ml","code_information":[{"code":"CP17744631830887633","type":"CDM"},{"code":"250","type":"RC"},{"code":"64094","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":58,"maximum":72,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Recombivax Hb 10 Mcg/ml Pfs=1","code_information":[{"code":"CP17744631830887009","type":"CDM"},{"code":"250","type":"RC"},{"code":"64094","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":58,"maximum":72,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Prednisolone Tab 5mg","code_information":[{"code":"CP17744631830815615","type":"CDM"},{"code":"250","type":"RC"},{"code":"42658016005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":72,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Prezista     Tab 800mg","code_information":[{"code":"CP17744631830839788","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676056630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":72,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Butrans      Dis 7.5/hr","code_information":[{"code":"CP17744631829048047","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011075704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":58,"maximum":72,"gross_charge":72,"discounted_cash":72,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":72},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cipro/dexa   Sus 0.3-0.1%","code_information":[{"code":"CP17744631829234429","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756042790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":57,"maximum":71,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Oxycontin    Tab 40mg Cr","code_information":[{"code":"CP17744631830712917","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":57,"maximum":71,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Oxycontin    Tab 40mg Er","code_information":[{"code":"CP17744631830724266","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011044020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":57,"maximum":71,"gross_charge":71,"discounted_cash":71,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":71},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Proair Respi Aer","code_information":[{"code":"CP17744631830831004","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310058020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proair Respi Aer 200 Inh","code_information":[{"code":"CP17744631830836533","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310058020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Aztreonam    Inj 2gm","code_information":[{"code":"CP17744631828812052","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Aztreonam 1gm/100ml Ns","code_information":[{"code":"CP17744631828811055","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Aztreonam 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828810126","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Aztreonam 2gm/100ml D5w","code_information":[{"code":"CP17744631828816248","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Freesty Libr Mis 2 Reader","code_information":[{"code":"CP17744631830002216","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599080300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freesty Libr Mis 3 Reader","code_information":[{"code":"CP17744631830005576","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599082000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyl Libre 14day Reader","code_information":[{"code":"CP17744631830000803","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599000200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle    Mis Reader","code_information":[{"code":"CP17744631830002467","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599000200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Icy Hot Tens Mis Therapy","code_information":[{"code":"CP17744631830137723","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167008045","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Libre-2 Freestyle Reader","code_information":[{"code":"CP17744631830327805","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599080300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Procto-med   Cre Hc 2.5%","code_information":[{"code":"CP17744631830837766","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315031228","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Tykerb       Tab 250mg","code_information":[{"code":"CP17744631831202776","type":"CDM"},{"code":"250","type":"RC"},{"code":"78067","type":"CPT","modifier":"119"}],"standard_charges":[{"setting":"outpatient","modifier_code":["119"],"minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Commode Hvy Duty","code_information":[{"code":"CP17744631829411187","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nourianz     Tab 20mg","code_information":[{"code":"CP17744631830575878","type":"CDM"},{"code":"250","type":"RC"},{"code":"42747060290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":56,"maximum":70,"gross_charge":70,"discounted_cash":70,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":70},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Striverdi    Aer 2.5mcg","code_information":[{"code":"CP17744631831070078","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Striverdi   Aer 2.5mcg 60inh","code_information":[{"code":"CP17744631831071044","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829265909","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238153206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol/cerave Moist Cream","code_information":[{"code":"CP17744631829376784","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238153206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clobetasol/cetaphi Moist Cream","code_information":[{"code":"CP17744631829375129","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238153206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 20mg Cr","code_information":[{"code":"CP17744631830717409","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxycontin    Tab 20mg Er","code_information":[{"code":"CP17744631830716958","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxycontin 20mg Er Tab","code_information":[{"code":"CP17744631830722162","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxycontin 20mg Tabs","code_information":[{"code":"CP17744631830725092","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxycontin Er 20mg Tabs","code_information":[{"code":"CP17744631830722079","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Noxafil      Tab 100mg","code_information":[{"code":"CP17744631830642407","type":"CDM"},{"code":"250","type":"RC"},{"code":"85432","type":"CPT","modifier":"402"}],"standard_charges":[{"setting":"outpatient","modifier_code":["402"],"minimum":55,"maximum":69,"gross_charge":69,"discounted_cash":69,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":69},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Caspofungin/ns 70mg/250ml","code_information":[{"code":"CP17744631829145285","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611070201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":68,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830408570","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762453802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":68,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lidocaine/hc Kit 3%-0.5%","code_information":[{"code":"CP17744631830332652","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925016520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":68,"gross_charge":68,"discounted_cash":68,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":68},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/salme Aer 250/50","code_information":[{"code":"CP17744631829989878","type":"CDM"},{"code":"250","type":"RC"},{"code":"54032","type":"CPT","modifier":"756"}],"standard_charges":[{"setting":"outpatient","modifier_code":["756"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Flutic/salme Aer 250/50 (60)","code_information":[{"code":"CP17744631829981317","type":"CDM"},{"code":"250","type":"RC"},{"code":"54032","type":"CPT","modifier":"756"}],"standard_charges":[{"setting":"outpatient","modifier_code":["756"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Flutic/salme Aer 250/50 60 Inh","code_information":[{"code":"CP17744631829985619","type":"CDM"},{"code":"250","type":"RC"},{"code":"54032","type":"CPT","modifier":"756"}],"standard_charges":[{"setting":"outpatient","modifier_code":["756"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Zylet        Sus 0.5-0.3%","code_information":[{"code":"CP17744631831416673","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208035805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ceftriaxone  Inj 10gm","code_information":[{"code":"CP17744631829170931","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Tobrex       Oin 0.3% Op","code_information":[{"code":"CP17744631831140926","type":"CDM"},{"code":"250","type":"RC"},{"code":"65064","type":"CPT","modifier":"435"}],"standard_charges":[{"setting":"outpatient","modifier_code":["435"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Testosterone Gel 1.62%","code_information":[{"code":"CP17744631831119518","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714096701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humalog 200 Units/ml Kwpen 3ml","code_information":[{"code":"CP17744631830082307","type":"CDM"},{"code":"250","type":"RC"},{"code":"27712","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":200,"type":"UN"}},{"description":"Humalog Kwik Inj 200/ml","code_information":[{"code":"CP17744631830080383","type":"CDM"},{"code":"250","type":"RC"},{"code":"27712","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Lyumjev 200 Units/ml Kwpen 3ml","code_information":[{"code":"CP17744631830399287","type":"CDM"},{"code":"250","type":"RC"},{"code":"28228","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":200,"type":"UN"}},{"description":"Lyumjev Kwpn Inj 200ut/ml","code_information":[{"code":"CP17744631830396577","type":"CDM"},{"code":"250","type":"RC"},{"code":"28228","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Calcipotrien Oin 0.005%","code_information":[{"code":"CP17744631829060620","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993087861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Vigamox      Dro 0.5%","code_information":[{"code":"CP17744631831270126","type":"CDM"},{"code":"250","type":"RC"},{"code":"78093","type":"CPT","modifier":"926"}],"standard_charges":[{"setting":"outpatient","modifier_code":["926"],"minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medicine Dispenser Tray","code_information":[{"code":"CP17744631830404747","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Abiraterone  Tab 500mg","code_information":[{"code":"CP17744631828140465","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238175406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Flutic/salme Aer 250/50","code_information":[{"code":"CP17744631829989791","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993058597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Flutic/salme Aer 250/50 60 Inh","code_information":[{"code":"CP17744631829982182","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993058597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Fluticasone/salm 250/50mcg Inh","code_information":[{"code":"CP17744631829983548","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993058597","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atelvia      Tab","code_information":[{"code":"CP17744631828778922","type":"CDM"},{"code":"250","type":"RC"},{"code":"43009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rollator Seat (Medicare","code_information":[{"code":"CP17744631830913208","type":"CDM"},{"code":"250","type":"RC"},{"code":"15600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54,"maximum":67,"gross_charge":67,"discounted_cash":67,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":67},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humalog      Inj 100/ml","code_information":[{"code":"CP17744631830089581","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":53,"maximum":66,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humalog 100 Units/ml Mdv 10ml","code_information":[{"code":"CP17744631830085328","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":53,"maximum":66,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog 100unit/ml Sol Vial","code_information":[{"code":"CP17744631830083931","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":53,"maximum":66,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog Inj 100/ml 10ml Vial","code_information":[{"code":"CP17744631830087437","type":"CDM"},{"code":"250","type":"RC"},{"code":"27510","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":53,"maximum":66,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Epogen       Inj 4000/ml","code_information":[{"code":"CP17744631829797666","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513014810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":53,"maximum":66,"gross_charge":66,"discounted_cash":66,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":66},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53}]}],"drug_information":{"unit":4000,"type":"EA"}},{"description":"Basaglar     Inj 100unit","code_information":[{"code":"CP17744631828834413","type":"CDM"},{"code":"250","type":"RC"},{"code":"27715","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Basaglar 100 Units/ml Pen 3ml","code_information":[{"code":"CP17744631828832333","type":"CDM"},{"code":"250","type":"RC"},{"code":"27715","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Basaglar Kwikpen 100iu/ml Sopn","code_information":[{"code":"CP17744631828836994","type":"CDM"},{"code":"250","type":"RC"},{"code":"27715","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":100,"type":"F2"}},{"description":"Flucelvax    Inj 2024-25","code_information":[{"code":"CP17744631829962154","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461065403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Flucelvax    Inj 2024-25","code_information":[{"code":"CP17744631829962643","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461055410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Flucelvax Mdv 24-25 5 Ml/ Vial","code_information":[{"code":"CP17744631829962469","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461055410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Flucelvax Pfs 24-25 0.5ml Dose","code_information":[{"code":"CP17744631829961063","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461065403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Flucelvax Pfs 24-25 Syr","code_information":[{"code":"CP17744631829962286","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461065403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lotemax      Sus 0.5%","code_information":[{"code":"CP17744631830373167","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Pressure Relief Shoe","code_information":[{"code":"CP17744631830820869","type":"CDM"},{"code":"250","type":"RC"},{"code":"92068","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":52,"maximum":65,"gross_charge":65,"discounted_cash":65,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":65},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Geodon       Inj 20mg","code_information":[{"code":"CP17744631830037247","type":"CDM"},{"code":"250","type":"RC"},{"code":"49392","type":"CPT","modifier":"83"}],"standard_charges":[{"setting":"outpatient","modifier_code":["83"],"minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Suflave      Sol","code_information":[{"code":"CP17744631831072221","type":"CDM"},{"code":"250","type":"RC"},{"code":"52268055001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aerobika     Mis","code_information":[{"code":"CP17744631828360695","type":"CDM"},{"code":"250","type":"RC"},{"code":"4351050512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Siklos       Tab 1000mg","code_information":[{"code":"CP17744631831013302","type":"CDM"},{"code":"250","type":"RC"},{"code":"71770012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Eysuvis      Dro 0.25%","code_information":[{"code":"CP17744631829837707","type":"CDM"},{"code":"250","type":"RC"},{"code":"71571033383","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Maxitrol     Oin 0.1% Op","code_information":[{"code":"CP17744631830405810","type":"CDM"},{"code":"250","type":"RC"},{"code":"78077","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breztri Aero  Sphere 120inh","code_information":[{"code":"CP17744631828944203","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Breztri Aero 160-9-4.8 Mcg 120","code_information":[{"code":"CP17744631828946231","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Breztri Aero Aer Sphere","code_information":[{"code":"CP17744631828949674","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breztri Aerosphere 120inh","code_information":[{"code":"CP17744631828944676","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Nitisinone   Cap 2mg","code_information":[{"code":"CP17744631830560394","type":"CDM"},{"code":"250","type":"RC"},{"code":"70505020260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aztreonam    Inj 2gm","code_information":[{"code":"CP17744631828817964","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Aztreonam 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828818809","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Aztreonam 2gm 100ml","code_information":[{"code":"CP17744631828817353","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Buprenorphin Dis 10mcg/hr","code_information":[{"code":"CP17744631828976429","type":"CDM"},{"code":"250","type":"RC"},{"code":"93365","type":"CPT","modifier":"740"}],"standard_charges":[{"setting":"outpatient","modifier_code":["740"],"minimum":51,"maximum":64,"gross_charge":64,"discounted_cash":64,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":64},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"But/apap/caf 50-325-40 Cap","code_information":[{"code":"CP17744631829011371","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862017901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829013214","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862017901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Butalb-aceta-caff 50-325-40 Cp","code_information":[{"code":"CP17744631829041141","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862017901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Natacyn      Sus 5% Op","code_information":[{"code":"CP17744631830540487","type":"CDM"},{"code":"250","type":"RC"},{"code":"71776000515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fanapt       Tab 12mg","code_information":[{"code":"CP17744631829843732","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068011202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Safety Pen Ndl (Securesaf) 30g","code_information":[{"code":"CP17744631830924838","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784096562","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":30,"type":"GR"}},{"description":"Securesafe   Mis 30gx5/16","code_information":[{"code":"CP17744631830996108","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784096562","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rebyota      Sus Fecal","code_information":[{"code":"CP17744631830885276","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566980002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pifeltro     Tab 100mg","code_information":[{"code":"CP17744631830763540","type":"CDM"},{"code":"250","type":"RC"},{"code":"63069","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levalbuterol Aer 45/act","code_information":[{"code":"CP17744631830296249","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Levalbuterol Aer 45/act 200inh","code_information":[{"code":"CP17744631830290692","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Levalbuterol Hfa 45mcg/act Inh","code_information":[{"code":"CP17744631830296742","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Kloxxado     Spr 8mg","code_information":[{"code":"CP17744631830196871","type":"CDM"},{"code":"250","type":"RC"},{"code":"59467067901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Narcan       Spr","code_information":[{"code":"CP17744631830541037","type":"CDM"},{"code":"250","type":"RC"},{"code":"69547035302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Narcan       Spr 4mg","code_information":[{"code":"CP17744631830541521","type":"CDM"},{"code":"250","type":"RC"},{"code":"69547035302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Narcan Nasal Spray 4mg 2-pk","code_information":[{"code":"CP17744631830545493","type":"CDM"},{"code":"250","type":"RC"},{"code":"69547035302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":63,"gross_charge":63,"discounted_cash":63,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":63},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828951216","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097031953","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":62,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Medipore H   Tap 2\"x10yds","code_information":[{"code":"CP17744631830409788","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333286201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":62,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epinephr Pro Kit 1mg/ml","code_information":[{"code":"CP17744631829790415","type":"CDM"},{"code":"250","type":"RC"},{"code":"24357001113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":62,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Relistor     Tab 150mg","code_information":[{"code":"CP17744631830887550","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649015090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":62,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Classics Rol Mis Walker","code_information":[{"code":"CP17744631829243344","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601001335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":62,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rollator Dura 7.5\" Wheel","code_information":[{"code":"CP17744631830919114","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":62,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Spr 20mg/act","code_information":[{"code":"CP17744631831082372","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097064448","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":50,"maximum":62,"gross_charge":62,"discounted_cash":62,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":62},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Truvada 200-300mg Tabs","code_information":[{"code":"CP17744631831194823","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958070101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cleocin      Sup 100mg","code_information":[{"code":"CP17744631829254656","type":"CDM"},{"code":"250","type":"RC"},{"code":"97667","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Xarelto      Tab 2.5mg","code_information":[{"code":"CP17744631831382248","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sunitinib    Cap 12.5mg","code_information":[{"code":"CP17744631831082627","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304009127","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Spiriva      Cap Handihlr","code_information":[{"code":"CP17744631831056280","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Spiriva Cap Handi 18mcg 5 Inh","code_information":[{"code":"CP17744631831053840","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Spiriva Handi 18mcg (5 Inh)","code_information":[{"code":"CP17744631831057838","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Alrex        Sus 0.2%","code_information":[{"code":"CP17744631828450539","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208035305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":49,"maximum":61,"gross_charge":61,"discounted_cash":61,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":61},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831115953","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571081941","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831110158","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571081951","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831118922","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729012953","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831113975","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729012954","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831117255","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080451","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831116664","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080414","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Abiraterone  Tab 500mg","code_information":[{"code":"CP17744631828146267","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Engerix-b    Inj 10/0.5ml","code_information":[{"code":"CP17744631829778921","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Flucelvax Pfs 2023 To 2024","code_information":[{"code":"CP17744631829965271","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461032303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluclvx Quad Inj 2023-24","code_information":[{"code":"CP17744631829967757","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461032303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Fluclvxqiv Pfs 23-24 0.5mldose","code_information":[{"code":"CP17744631829963588","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461032303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Caplyta      Cap 10.5mg","code_information":[{"code":"CP17744631829103451","type":"CDM"},{"code":"250","type":"RC"},{"code":"72060011040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":105,"type":"ME"}},{"description":"Caplyta      Cap 21mg","code_information":[{"code":"CP17744631829103011","type":"CDM"},{"code":"250","type":"RC"},{"code":"72060012140","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Caplyta      Cap 42mg","code_information":[{"code":"CP17744631829100537","type":"CDM"},{"code":"250","type":"RC"},{"code":"72060014240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":42,"type":"ME"}},{"description":"Omnipod      Mis 5 Pack","code_information":[{"code":"CP17744631830681620","type":"CDM"},{"code":"250","type":"RC"},{"code":"8508200005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omnipod Dash Mis Pods","code_information":[{"code":"CP17744631830681117","type":"CDM"},{"code":"250","type":"RC"},{"code":"8508200005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fondaparinux Inj 7.5/0.6","code_information":[{"code":"CP17744631829995064","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457058406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":48,"maximum":60,"gross_charge":60,"discounted_cash":60,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":60},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Azactam      Inj 2gm","code_information":[{"code":"CP17744631828801444","type":"CDM"},{"code":"250","type":"RC"},{"code":"32570","type":"CPT","modifier":"16"}],"standard_charges":[{"setting":"outpatient","modifier_code":["16"],"minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Aztreonam 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828813398","type":"CDM"},{"code":"250","type":"RC"},{"code":"32570","type":"CPT","modifier":"16"}],"standard_charges":[{"setting":"outpatient","modifier_code":["16"],"minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Aztreonam 2gm/100ml Ns El-d","code_information":[{"code":"CP17744631828816521","type":"CDM"},{"code":"250","type":"RC"},{"code":"32570","type":"CPT","modifier":"16"}],"standard_charges":[{"setting":"outpatient","modifier_code":["16"],"minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Pokonza      Pow 10meq","code_information":[{"code":"CP17744631830789950","type":"CDM"},{"code":"250","type":"RC"},{"code":"15370030560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831118964","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Interdry     Mis 10\"x36\"","code_information":[{"code":"CP17744631830156447","type":"CDM"},{"code":"250","type":"RC"},{"code":"11701006932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Interdry 10\"x36\" Sheet","code_information":[{"code":"CP17744631830153817","type":"CDM"},{"code":"250","type":"RC"},{"code":"11701006932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Interdry Sheet 10\"x36\"","code_information":[{"code":"CP17744631830158439","type":"CDM"},{"code":"250","type":"RC"},{"code":"11701006932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Imatinib Mes Tab 400mg","code_information":[{"code":"CP17744631830131865","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335047583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Imatinib Mesylate 400mg Tabs","code_information":[{"code":"CP17744631830135604","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335047583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Buprenorphin Dis 5mcg/hr","code_information":[{"code":"CP17744631828979625","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858075040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lokelma      Pak 10gm","code_information":[{"code":"CP17744631830351941","type":"CDM"},{"code":"250","type":"RC"},{"code":"31011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Neupro       Dis 4mg/24hr","code_information":[{"code":"CP17744631830558115","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Neupro 4mg/24hr Patch","code_information":[{"code":"CP17744631830554862","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Glucerna     Liq Vanilla","code_information":[{"code":"CP17744631830047897","type":"CDM"},{"code":"250","type":"RC"},{"code":"70074050241","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compmist Nebulizer","code_information":[{"code":"CP17744631829418842","type":"CDM"},{"code":"250","type":"RC"},{"code":"67056014001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mephyton 5mg Tabs","code_information":[{"code":"CP17744631830429474","type":"CDM"},{"code":"250","type":"RC"},{"code":"18717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bathtub Transfer Bench W/back","code_information":[{"code":"CP17744631828844392","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601002153","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":47,"maximum":59,"gross_charge":59,"discounted_cash":59,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":59},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bepreve      Dro 1.5%","code_information":[{"code":"CP17744631828867846","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208062902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Shower Chairback & Arm","code_information":[{"code":"CP17744631831019686","type":"CDM"},{"code":"250","type":"RC"},{"code":"82238356003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Temozolomide Cap 140mg","code_information":[{"code":"CP17744631831110334","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Fentanyl     Dis 50mcg/hr","code_information":[{"code":"CP17744631829850835","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Toner Cart Tn-450 Tn-420","code_information":[{"code":"CP17744631831155682","type":"CDM"},{"code":"250","type":"RC"},{"code":"70856204234","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Toner Cartridge Black","code_information":[{"code":"CP17744631831159603","type":"CDM"},{"code":"250","type":"RC"},{"code":"70856204234","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Octreotide   Inj 500mcg","code_information":[{"code":"CP17744631830656718","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dasatinib    Tab 50mg","code_information":[{"code":"CP17744631829547570","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505362906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lybalvi      Tab 10-10mg","code_information":[{"code":"CP17744631830389294","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757065242","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lybalvi      Tab 15-10mg","code_information":[{"code":"CP17744631830382194","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757065342","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lybalvi      Tab 20-10mg","code_information":[{"code":"CP17744631830382525","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757065442","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lybalvi      Tab 5-10mg","code_information":[{"code":"CP17744631830386266","type":"CDM"},{"code":"250","type":"RC"},{"code":"65757065142","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":58,"gross_charge":58,"discounted_cash":58,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":58},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Creon        Cap 12000unt","code_information":[{"code":"CP17744631829429243","type":"CDM"},{"code":"250","type":"RC"},{"code":"32004","type":"CPT","modifier":"770"}],"standard_charges":[{"setting":"outpatient","modifier_code":["770"],"minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":12000,"type":"EA"}},{"description":"Flucelvax Quad Vial(5 Ml/vial)","code_information":[{"code":"CP17744631829960831","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461042310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fluclvx Quad Inj 2023-24","code_information":[{"code":"CP17744631829965525","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461042310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Caplyta      Cap 42mg","code_information":[{"code":"CP17744631829101050","type":"CDM"},{"code":"250","type":"RC"},{"code":"72060014230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":42,"type":"ME"}},{"description":"Fluclvx Quad Inj 2022-23","code_information":[{"code":"CP17744631829962024","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461032203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":2022,"type":"EA"}},{"description":"Dronabinol   Cap 5mg","code_information":[{"code":"CP17744631829742480","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687038694","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mepilex Border Foam 6x6","code_information":[{"code":"CP17744631830427587","type":"CDM"},{"code":"250","type":"RC"},{"code":"83180295490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acular Ls    Sol 0.4%","code_information":[{"code":"CP17744631828327379","type":"CDM"},{"code":"250","type":"RC"},{"code":"23927","type":"CPT","modifier":"705"}],"standard_charges":[{"setting":"outpatient","modifier_code":["705"],"minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Imatinib Mes Tab 400mg","code_information":[{"code":"CP17744631830132414","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":46,"maximum":57,"gross_charge":57,"discounted_cash":57,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":57},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Tdvax        Inj 2-2 Lf","code_information":[{"code":"CP17744631831103271","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":56,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Tdvax Vials 0.5 Ml Dose","code_information":[{"code":"CP17744631831107033","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":56,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fingolimod   Cap 0.5mg","code_information":[{"code":"CP17744631829951803","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729034210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":45,"maximum":56,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fingolimod   Cap 0.5mg","code_information":[{"code":"CP17744631829957384","type":"CDM"},{"code":"250","type":"RC"},{"code":"37845","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45,"maximum":56,"gross_charge":56,"discounted_cash":56,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":56},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dorzol/timol Sol 2-0.5%op","code_information":[{"code":"CP17744631829727870","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571014726","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829727851","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571014726","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Pulmozyme    Sol 1mg/ml","code_information":[{"code":"CP17744631830851572","type":"CDM"},{"code":"250","type":"RC"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Multaq       Tab 400mg","code_information":[{"code":"CP17744631830528831","type":"CDM"},{"code":"250","type":"RC"},{"code":"24414","type":"CPT","modifier":"260"}],"standard_charges":[{"setting":"outpatient","modifier_code":["260"],"minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Unknown Drug","code_information":[{"code":"CP17744631831204464","type":"CDM"},{"code":"250","type":"RC"},{"code":"CP17744631831204464","type":"LOCAL"}],"standard_charges":[{"setting":"outpatient","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fosamax + D  Tab 70-2800","code_information":[{"code":"CP17744631829997802","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206013701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Fosamax + D Tab 70-2800","code_information":[{"code":"CP17744631829994940","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206013701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Imatinib Mes Tab 400mg","code_information":[{"code":"CP17744631830132743","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651024130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Imatinib Mes Tab 400mg","code_information":[{"code":"CP17744631830134218","type":"CDM"},{"code":"250","type":"RC"},{"code":"93763","type":"CPT","modifier":"56"}],"standard_charges":[{"setting":"outpatient","modifier_code":["56"],"minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Imatinib Mes Tab 400mg","code_information":[{"code":"CP17744631830133101","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991037733","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":44,"maximum":55,"gross_charge":55,"discounted_cash":55,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":55},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Arimidex     Tab 1mg","code_information":[{"code":"CP17744631828749151","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559067030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dorzol/timol 2/.5% Os Pf Bp","code_information":[{"code":"CP17744631829727122","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571038273","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dorzol/timol Sol 2%-0.5%","code_information":[{"code":"CP17744631829724722","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571038273","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Drozol/timol Sol 2%-0.5%","code_information":[{"code":"CP17744631829750190","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571038273","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Teriflunomid Tab 14mg","code_information":[{"code":"CP17744631831114428","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291083130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Bortezomib   Inj 3.5mg","code_information":[{"code":"CP17744631828945287","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742048401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Novopen Echo Mis","code_information":[{"code":"CP17744631830648267","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trintellix   Tab 20mg","code_information":[{"code":"CP17744631831191773","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764075030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluclvx Quad Inj 2022-23","code_information":[{"code":"CP17744631829963583","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461042210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":2022,"type":"EA"}},{"description":"Vemlidy      Tab 25mg","code_information":[{"code":"CP17744631831255704","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958230101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sensipar     Tab 60mg","code_information":[{"code":"CP17744631831007651","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513007430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Flutic/salme Aer 100/50","code_information":[{"code":"CP17744631829984633","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993058497","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Flutic/salme Aer 100/50 60 Inh","code_information":[{"code":"CP17744631829984917","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993058497","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Fluticasone/salm 100/50mcg Inh","code_information":[{"code":"CP17744631829984113","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993058497","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dexameth Pho Sol 0.1% Op","code_information":[{"code":"CP17744631829573741","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":43,"maximum":54,"gross_charge":54,"discounted_cash":54,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":54},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fosfomycin   Pow 3gm","code_information":[{"code":"CP17744631829996346","type":"CDM"},{"code":"250","type":"RC"},{"code":"82036427401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Procrit      Inj 2000/ml","code_information":[{"code":"CP17744631830833561","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676030201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":2000,"type":"EA"}},{"description":"Vraylar      Cap 1.5mg","code_information":[{"code":"CP17744631831300455","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874011530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Vraylar      Cap 1.5mg","code_information":[{"code":"CP17744631831301788","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874011520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Vraylar      Cap 3mg","code_information":[{"code":"CP17744631831308868","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874013030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Vraylar      Cap 4.5mg","code_information":[{"code":"CP17744631831309237","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874014530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Vraylar      Cap 6mg","code_information":[{"code":"CP17744631831304975","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874016030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Vraylar 1.5mg Caps","code_information":[{"code":"CP17744631831307718","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874011530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Vraylar 6mg Caps","code_information":[{"code":"CP17744631831305634","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874016030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Granisetron  Tab 1mg","code_information":[{"code":"CP17744631830052460","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452035011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nucynta Er   Tab 250mg","code_information":[{"code":"CP17744631830649124","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510029160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Nitro-dur    Dis 0.3mg/hr","code_information":[{"code":"CP17744631830566690","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742051530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Caspofungin 50mg/250ml Nacl","code_information":[{"code":"CP17744631829142784","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fentanyl     Dis 62.5mcg","code_information":[{"code":"CP17744631829856386","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Flucelvax Prefill Syringe 0.5m","code_information":[{"code":"CP17744631829963459","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461032103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluclvx Quad Inj 2021-22","code_information":[{"code":"CP17744631829962821","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461032103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":2021,"type":"EA"}},{"description":"Aciphex      Tab 20mg","code_information":[{"code":"CP17744631828321008","type":"CDM"},{"code":"250","type":"RC"},{"code":"80725024330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":53,"gross_charge":53,"discounted_cash":53,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":53},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ambrisentan  Tab 5mg","code_information":[{"code":"CP17744631828469339","type":"CDM"},{"code":"250","type":"RC"},{"code":"37842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Creon        Cap 24000unt","code_information":[{"code":"CP17744631829429048","type":"CDM"},{"code":"250","type":"RC"},{"code":"32122","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":24000,"type":"EA"}},{"description":"Rexulti      Tab 0.25mg","code_information":[{"code":"CP17744631830894848","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Rexulti      Tab 0.5mg","code_information":[{"code":"CP17744631830895950","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rexulti      Tab 1mg","code_information":[{"code":"CP17744631830894145","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Rexulti      Tab 2mg","code_information":[{"code":"CP17744631830897601","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Rexulti      Tab 3mg","code_information":[{"code":"CP17744631830896712","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rexulti      Tab 4mg","code_information":[{"code":"CP17744631830893700","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148004013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Rexulti 1mg Tabs","code_information":[{"code":"CP17744631830897072","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Rexulti 2mg Tabs","code_information":[{"code":"CP17744631830895972","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Rexulti 3mg Tabs","code_information":[{"code":"CP17744631830897097","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148003913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Bromsite     Dro 0.075%","code_information":[{"code":"CP17744631828951255","type":"CDM"},{"code":"250","type":"RC"},{"code":"49708075441","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lotemax      Gel 0.5%","code_information":[{"code":"CP17744631830373976","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lotemax Sm   Gel 0.38%","code_information":[{"code":"CP17744631830373438","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":38,"type":"EA"}},{"description":"Depo-estradi Inj 5mg/ml","code_information":[{"code":"CP17744631829559523","type":"CDM"},{"code":"250","type":"RC"},{"code":"90271","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluocin Acet Oil 0.01%","code_information":[{"code":"CP17744631829962187","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802000910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluocinolone Otic 0.01% Oil","code_information":[{"code":"CP17744631829972557","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802000910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":42,"maximum":52,"gross_charge":52,"discounted_cash":52,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":52},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Secuado      Dis 3.8mg","code_information":[{"code":"CP17744631830996048","type":"CDM"},{"code":"250","type":"RC"},{"code":"68968017203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":38,"type":"ME"}},{"description":"Secuado      Dis 5.7mg","code_information":[{"code":"CP17744631830992300","type":"CDM"},{"code":"250","type":"RC"},{"code":"68968017303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":57,"type":"ME"}},{"description":"Secuado      Dis 7.6mg","code_information":[{"code":"CP17744631830999108","type":"CDM"},{"code":"250","type":"RC"},{"code":"68968017403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":76,"type":"ME"}},{"description":"Butrans      Dis 5mcg/hr","code_information":[{"code":"CP17744631829045683","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011075004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Butrans 5mcg/hr Patch","code_information":[{"code":"CP17744631829048586","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011075004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ambrisentan  Tab 5mg","code_information":[{"code":"CP17744631828466203","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335023683","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Plenvu       Sol","code_information":[{"code":"CP17744631830785585","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649040001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxacillin    Inj 10gm","code_information":[{"code":"CP17744631830696557","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Oxacillin 12 Gm/500ml Ns","code_information":[{"code":"CP17744631830708750","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Oxacillin 12g In 1000ml Ns","code_information":[{"code":"CP17744631830709997","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Oxacillin 6gm/500ml","code_information":[{"code":"CP17744631830703671","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":6,"type":"GR"}},{"description":"Acyclovir    Cre 5%","code_information":[{"code":"CP17744631828325146","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802004475","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Pen. G 3mu/100ml Ns","code_information":[{"code":"CP17744631830747559","type":"CDM"},{"code":"250","type":"RC"},{"code":"49053","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Penicilin Gk Inj 18mu/1000ml","code_information":[{"code":"CP17744631830743782","type":"CDM"},{"code":"250","type":"RC"},{"code":"49053","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Penicilin Gk Inj 24mu/1000 Ns","code_information":[{"code":"CP17744631830747981","type":"CDM"},{"code":"250","type":"RC"},{"code":"49053","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":24,"type":"EA"}},{"description":"Penicillin Gk Inj 24mu/1000 D5","code_information":[{"code":"CP17744631830746538","type":"CDM"},{"code":"250","type":"RC"},{"code":"49053","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":24,"type":"EA"}},{"description":"Moxifloxacin Sol 0.5%","code_information":[{"code":"CP17744631830519945","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180042101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":41,"maximum":51,"gross_charge":51,"discounted_cash":51,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":51},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Trexall      Tab 10mg","code_information":[{"code":"CP17744631831177367","type":"CDM"},{"code":"250","type":"RC"},{"code":"51285036801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zolmitriptan Spr 5mg","code_information":[{"code":"CP17744631831400221","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802071191","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluclvx Quad Inj 2021-22","code_information":[{"code":"CP17744631829967651","type":"CDM"},{"code":"250","type":"RC"},{"code":"70461042110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":2021,"type":"EA"}},{"description":"Glatopa      Inj 20mg/ml","code_information":[{"code":"CP17744631830038951","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxygen","code_information":[{"code":"CP17744631830725857","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999999910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Con 100/5ml","code_information":[{"code":"CP17744631830719044","type":"CDM"},{"code":"250","type":"RC"},{"code":"40685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ambrisentan  Tab 10mg","code_information":[{"code":"CP17744631828466515","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097038702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Adderall Xr  Cap 15mg","code_information":[{"code":"CP17744631828342280","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092038501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828953621","type":"CDM"},{"code":"250","type":"RC"},{"code":"93681","type":"CPT","modifier":"673"}],"standard_charges":[{"setting":"outpatient","modifier_code":["673"],"minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828961349","type":"CDM"},{"code":"250","type":"RC"},{"code":"11516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Budesonide-0.5mg/2ml-susp","code_information":[{"code":"CP17744631828965414","type":"CDM"},{"code":"250","type":"RC"},{"code":"93681","type":"CPT","modifier":"673"}],"standard_charges":[{"setting":"outpatient","modifier_code":["673"],"minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Arava        Tab 20mg","code_information":[{"code":"CP17744631828731781","type":"CDM"},{"code":"250","type":"RC"},{"code":"88216","type":"CPT","modifier":"130"}],"standard_charges":[{"setting":"outpatient","modifier_code":["130"],"minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Desmopressin Spr 0.01%","code_information":[{"code":"CP17744631829560819","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505081500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epogen       Inj 3000/ml","code_information":[{"code":"CP17744631829791813","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513026710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":3000,"type":"EA"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828953967","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714001930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hizentra     Inj 10/50ml","code_information":[{"code":"CP17744631830088238","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206045510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Hizentra     Inj 2gm/10ml","code_information":[{"code":"CP17744631830083748","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206045202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Desmopressin Inj 4mcg/ml","code_information":[{"code":"CP17744631829563316","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918090110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":40,"maximum":50,"gross_charge":50,"discounted_cash":50,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":50},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Edurant      Tab 25mg","code_information":[{"code":"CP17744631829767337","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676027801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Edurant 25mg Tabs","code_information":[{"code":"CP17744631829761006","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676027801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Qnasl Child  Spr 40mcg","code_information":[{"code":"CP17744631830864139","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310040606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Novolin R    Inj U-100","code_information":[{"code":"CP17744631830578424","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Novolin R 100 Unit/ml Mdv10ml","code_information":[{"code":"CP17744631830578309","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolin R 100unit/ml Soln","code_information":[{"code":"CP17744631830574850","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Acyclovir    Cre 5%","code_information":[{"code":"CP17744631828322950","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162083614","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Aerchmbr Pls Mis Flow-vu","code_information":[{"code":"CP17744631828364739","type":"CDM"},{"code":"250","type":"RC"},{"code":"45607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aerchmbr Pls Mis Lrg Mask","code_information":[{"code":"CP17744631828367537","type":"CDM"},{"code":"250","type":"RC"},{"code":"45607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aerchmbr Pls Mis Sm Mask","code_information":[{"code":"CP17744631828367063","type":"CDM"},{"code":"250","type":"RC"},{"code":"45607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenobarb    Inj 130mg/ml","code_information":[{"code":"CP17744631830752281","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":130,"type":"ME"}},{"description":"Teriflunomid Tab 14mg","code_information":[{"code":"CP17744631831119998","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729040010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Buprenorphin Dis 15mcg/hr","code_information":[{"code":"CP17744631828974326","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238120402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Teriflunomid Tab 14mg","code_information":[{"code":"CP17744631831110714","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722024730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Teriflunomid Tab 14mg","code_information":[{"code":"CP17744631831118316","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651005530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Latuda       Tab 20mg","code_information":[{"code":"CP17744631830220351","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402030230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Latuda       Tab 40mg","code_information":[{"code":"CP17744631830227493","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402030430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Latuda       Tab 60mg","code_information":[{"code":"CP17744631830223373","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402030630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Latuda       Tab 80mg","code_information":[{"code":"CP17744631830229523","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402030830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Latuda 20mg Tabs","code_information":[{"code":"CP17744631830223507","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402030230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Latuda 80mg Tabs","code_information":[{"code":"CP17744631830220000","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402030830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":39,"maximum":49,"gross_charge":49,"discounted_cash":49,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":49},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Entresto     Tab 49-51mg","code_information":[{"code":"CP17744631829794087","type":"CDM"},{"code":"250","type":"RC"},{"code":"78077","type":"CPT","modifier":"767"}],"standard_charges":[{"setting":"outpatient","modifier_code":["767"],"minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":49,"type":"ME"}},{"description":"Entresto     Tab 97-103mg","code_information":[{"code":"CP17744631829799308","type":"CDM"},{"code":"250","type":"RC"},{"code":"78069","type":"CPT","modifier":"620"}],"standard_charges":[{"setting":"outpatient","modifier_code":["620"],"minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":97,"type":"ME"}},{"description":"Entresto 97/103mg Tabs","code_information":[{"code":"CP17744631829792548","type":"CDM"},{"code":"250","type":"RC"},{"code":"78069","type":"CPT","modifier":"620"}],"standard_charges":[{"setting":"outpatient","modifier_code":["620"],"minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":97,"type":"ME"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830330984","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629875501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vraylar      Cap 1.5-3mg","code_information":[{"code":"CP17744631831307101","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874017008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Erlotinib    Tab 150mg","code_information":[{"code":"CP17744631829791087","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485021930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Teriflunomid Tab 14mg","code_information":[{"code":"CP17744631831117320","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598028130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Shower Chair W/bk & Arms","code_information":[{"code":"CP17744631831013021","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922193","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"A.f.o. Brace Right Foot","code_information":[{"code":"CP17744631828106921","type":"CDM"},{"code":"250","type":"RC"},{"code":"30244","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":38,"maximum":48,"gross_charge":48,"discounted_cash":48,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":48},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tubigrip Size D Tubular","code_information":[{"code":"CP17744631831193330","type":"CDM"},{"code":"250","type":"RC"},{"code":"31514","type":"CPT","modifier":"37"}],"standard_charges":[{"setting":"outpatient","modifier_code":["37"],"minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zyprexa 20mg Tabs","code_information":[{"code":"CP17744631831411638","type":"CDM"},{"code":"250","type":"RC"},{"code":"24420","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Veltassa     Pow 8.4gm","code_information":[{"code":"CP17744631831258305","type":"CDM"},{"code":"250","type":"RC"},{"code":"53436008404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":84,"type":"GR"}},{"description":"Ensure Nutri Liq Chocolat","code_information":[{"code":"CP17744631829786412","type":"CDM"},{"code":"250","type":"RC"},{"code":"70074057231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sotrovimab   Inj 500/8ml","code_information":[{"code":"CP17744631831057238","type":"CDM"},{"code":"250","type":"RC"},{"code":"17309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Latex Glovesmed","code_information":[{"code":"CP17744631830229205","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784023379","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Airsupra     Aer 90-80mcg","code_information":[{"code":"CP17744631828371707","type":"CDM"},{"code":"250","type":"RC"},{"code":"31090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Airsupra  Aer 90-80mcg 120 Inh","code_information":[{"code":"CP17744631828376526","type":"CDM"},{"code":"250","type":"RC"},{"code":"31090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Quake        Mis","code_information":[{"code":"CP17744631830869144","type":"CDM"},{"code":"250","type":"RC"},{"code":"8348129700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829104329","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111049704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Wheelchair Leg Rest","code_information":[{"code":"CP17744631831374958","type":"CDM"},{"code":"250","type":"RC"},{"code":"82238316126","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Loteprednol  Sus 0.5%","code_information":[{"code":"CP17744631830372889","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603032401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ampicillin   Inj 1gm","code_information":[{"code":"CP17744631828528423","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Lanthanum    Chw 1000mg","code_information":[{"code":"CP17744631830210017","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993042475","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":38,"maximum":47,"gross_charge":47,"discounted_cash":47,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":47},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Timolol Gel  Sol 0.5% Op","code_information":[{"code":"CP17744631831136139","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332054605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Maxalt       Tab 10mg","code_information":[{"code":"CP17744631830401721","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206014201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Xulane       Dis 150-35","code_information":[{"code":"CP17744631831381129","type":"CDM"},{"code":"250","type":"RC"},{"code":"37833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clobetasol   Sha 0.05%","code_information":[{"code":"CP17744631829364833","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Aptiom       Tab 200mg","code_information":[{"code":"CP17744631828733513","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402020230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Aptiom       Tab 400mg","code_information":[{"code":"CP17744631828730575","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402020430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Aptiom       Tab 600mg","code_information":[{"code":"CP17744631828730470","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402020660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Wound Measuring Tape","code_information":[{"code":"CP17744631831388652","type":"CDM"},{"code":"250","type":"RC"},{"code":"63441300000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxcarbazepin Tab 300mg Er","code_information":[{"code":"CP17744631830707859","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241030501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Besivance    Sus 0.6%","code_information":[{"code":"CP17744631828866380","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208044605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Cefotetan    Inj 2gm/20ml","code_information":[{"code":"CP17744631829177997","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323038620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefotetan 2gm/100ml Ns","code_information":[{"code":"CP17744631829175170","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323038620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Erlotinib    Tab 150mg","code_information":[{"code":"CP17744631829798684","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991089233","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ferrous Sulf Sol 300/5ml","code_information":[{"code":"CP17744631829869188","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ferrous Sulf Syp 300/5ml","code_information":[{"code":"CP17744631829862488","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Bimatoprost  Sol 0.03%","code_information":[{"code":"CP17744631828881855","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332050725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Bimatoprost  Sol 0.03% Op","code_information":[{"code":"CP17744631828884550","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332050725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":37,"maximum":46,"gross_charge":46,"discounted_cash":46,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":46},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Orilissa     Tab 150mg","code_information":[{"code":"CP17744631830693353","type":"CDM"},{"code":"250","type":"RC"},{"code":"74003","type":"CPT","modifier":"828"}],"standard_charges":[{"setting":"outpatient","modifier_code":["828"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Retacrit     Inj 4000unit","code_information":[{"code":"CP17744631830890424","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"710"}],"standard_charges":[{"setting":"outpatient","modifier_code":["710"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":4000,"type":"UN"}},{"description":"Xeloda       Tab 500mg","code_information":[{"code":"CP17744631831381793","type":"CDM"},{"code":"250","type":"RC"},{"code":"41101","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830796487","type":"CDM"},{"code":"250","type":"RC"},{"code":"60315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mestinon     Tab Timespan","code_information":[{"code":"CP17744631830434446","type":"CDM"},{"code":"250","type":"RC"},{"code":"18730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Afo Foot Drop Brace","code_information":[{"code":"CP17744631828361439","type":"CDM"},{"code":"250","type":"RC"},{"code":"79811","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Peg/nasul/c/ Sol Nacl/pot","code_information":[{"code":"CP17744631830740611","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682020175","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Resting Hand Splint","code_information":[{"code":"CP17744631830898810","type":"CDM"},{"code":"250","type":"RC"},{"code":"46180000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alvesco      Aer 160mcg","code_information":[{"code":"CP17744631828455495","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515071201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Alvesco      Aer 80mcg","code_information":[{"code":"CP17744631828458877","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515071101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Alvesco   Aer 160mcg 60 Inh","code_information":[{"code":"CP17744631828459752","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515071201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Vancomycin 1.75gm/500ml Ns","code_information":[{"code":"CP17744631831244623","type":"CDM"},{"code":"250","type":"RC"},{"code":"72078006599","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Alocril      Sol 2%","code_information":[{"code":"CP17744631828437048","type":"CDM"},{"code":"250","type":"RC"},{"code":"23884","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Nuvessa      Gel 1.3%","code_information":[{"code":"CP17744631830644537","type":"CDM"},{"code":"250","type":"RC"},{"code":"64274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":13,"type":"EA"}},{"description":"Humulin  *Discontinued","code_information":[{"code":"CP17744631830095763","type":"CDM"},{"code":"250","type":"RC"},{"code":"28315","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humulin N    Inj U-100","code_information":[{"code":"CP17744631830094082","type":"CDM"},{"code":"250","type":"RC"},{"code":"28315","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humulin N 100 Unit/ml Mdv 3ml","code_information":[{"code":"CP17744631830098369","type":"CDM"},{"code":"250","type":"RC"},{"code":"28315","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humulin N 100unit/ml 3ml Disc","code_information":[{"code":"CP17744631830090341","type":"CDM"},{"code":"250","type":"RC"},{"code":"28315","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humulin N 100unit/ml Susp","code_information":[{"code":"CP17744631830096090","type":"CDM"},{"code":"250","type":"RC"},{"code":"28315","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Tubigrip Size C Tubular","code_information":[{"code":"CP17744631831199256","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Buprenorphin Dis 5mcg/hr","code_information":[{"code":"CP17744631828986765","type":"CDM"},{"code":"250","type":"RC"},{"code":"93365","type":"CPT","modifier":"640"}],"standard_charges":[{"setting":"outpatient","modifier_code":["640"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Xcopri       Pak 150-200","code_information":[{"code":"CP17744631831380172","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699020328","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xcopri       Pak 50-100mg","code_information":[{"code":"CP17744631831388644","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699020228","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hydromorphon Liq 1mg/ml","code_information":[{"code":"CP17744631830110731","type":"CDM"},{"code":"250","type":"RC"},{"code":"54038","type":"CPT","modifier":"663"}],"standard_charges":[{"setting":"outpatient","modifier_code":["663"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Betoptic-s   Sus 0.25% Op","code_information":[{"code":"CP17744631828877900","type":"CDM"},{"code":"250","type":"RC"},{"code":"78072","type":"CPT","modifier":"910"}],"standard_charges":[{"setting":"outpatient","modifier_code":["910"],"minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Walker Folding Adult","code_information":[{"code":"CP17744631831304859","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Walker Folding Bariatric","code_information":[{"code":"CP17744631831300130","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":36,"maximum":45,"gross_charge":45,"discounted_cash":45,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":45},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hemi Walker","code_information":[{"code":"CP17744631830078024","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601063250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Voriconazole Tab 200mg","code_information":[{"code":"CP17744631831301690","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714019901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Zovirax      Cre 5%","code_information":[{"code":"CP17744631831413648","type":"CDM"},{"code":"250","type":"RC"},{"code":"18709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Zovirax 5% Cream","code_information":[{"code":"CP17744631831417788","type":"CDM"},{"code":"250","type":"RC"},{"code":"18709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Humulin R    Inj U-100","code_information":[{"code":"CP17744631830097431","type":"CDM"},{"code":"250","type":"RC"},{"code":"28215","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humulin R 100 Unit/ml Mdv 10ml","code_information":[{"code":"CP17744631830091252","type":"CDM"},{"code":"250","type":"RC"},{"code":"28215","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Prednisolone Sus 1% Op","code_information":[{"code":"CP17744631830810658","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758011905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829784381","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Full Face Mask Lrg Cpap","code_information":[{"code":"CP17744631830002158","type":"CDM"},{"code":"250","type":"RC"},{"code":"92237604830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atropine 0.01% Opth Solution","code_information":[{"code":"CP17744631828796917","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219174903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828797405","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219174903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vitamin K1   Inj 10mg/ml","code_information":[{"code":"CP17744631831300339","type":"CDM"},{"code":"250","type":"RC"},{"code":"40991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Durezol      Emu 0.05%","code_information":[{"code":"CP17744631829762621","type":"CDM"},{"code":"250","type":"RC"},{"code":"65924","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Durezol 0.05% Ophth Emulsion","code_information":[{"code":"CP17744631829761360","type":"CDM"},{"code":"250","type":"RC"},{"code":"65924","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":35,"maximum":44,"gross_charge":44,"discounted_cash":44,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":44},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Percocet     Tab 10-325mg","code_information":[{"code":"CP17744631830759281","type":"CDM"},{"code":"250","type":"RC"},{"code":"63481062970","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fentanyl     Dis 37.5mcg","code_information":[{"code":"CP17744631829851771","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Temozolomide Cap 100mg","code_information":[{"code":"CP17744631831114373","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571081841","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Temozolomide Cap 100mg","code_information":[{"code":"CP17744631831114481","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080314","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Temozolomide Cap 100mg","code_information":[{"code":"CP17744631831117665","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571081851","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Temozolomide Cap 100mg","code_information":[{"code":"CP17744631831119798","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080351","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Rayaldee     Cap 30mcg","code_information":[{"code":"CP17744631830874697","type":"CDM"},{"code":"250","type":"RC"},{"code":"70301100201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Bevespi      Aer 9-4.8mcg","code_information":[{"code":"CP17744631828875441","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Bevespi Aer 9-4.8mcg 120inh","code_information":[{"code":"CP17744631828877330","type":"CDM"},{"code":"250","type":"RC"},{"code":"31046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Vancomycin 2 Grams/400 Ml El-l","code_information":[{"code":"CP17744631831242533","type":"CDM"},{"code":"250","type":"RC"},{"code":"72078006699","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Iodosorb     Gel","code_information":[{"code":"CP17744631830159509","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565012249","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iodosorb 0.9% Gel","code_information":[{"code":"CP17744631830155005","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565012249","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Oxcarbazepin Sus 300mg/5m","code_information":[{"code":"CP17744631830709257","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452012550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Fentanyl     Dis 100mcg/h","code_information":[{"code":"CP17744631829853495","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Xhance       Mis 93mcg","code_information":[{"code":"CP17744631831387617","type":"CDM"},{"code":"250","type":"RC"},{"code":"71143037501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":93,"type":"ME"}},{"description":"Northera     Cap 100mg","code_information":[{"code":"CP17744631830578600","type":"CDM"},{"code":"250","type":"RC"},{"code":"67386082019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Northera 100mg Caps","code_information":[{"code":"CP17744631830578926","type":"CDM"},{"code":"250","type":"RC"},{"code":"67386082019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lidocaine/hc Kit 3%-1%","code_information":[{"code":"CP17744631830334801","type":"CDM"},{"code":"250","type":"RC"},{"code":"59088077120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bexarotene   Cap 75mg","code_information":[{"code":"CP17744631828878887","type":"CDM"},{"code":"250","type":"RC"},{"code":"59128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Glucometergluco Perfct","code_information":[{"code":"CP17744631830041625","type":"CDM"},{"code":"250","type":"RC"},{"code":"60541650607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zafemy       Dis 150/35","code_information":[{"code":"CP17744631831394880","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162035803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zolmitriptan Spr 5mg","code_information":[{"code":"CP17744631831402932","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238200706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":43,"gross_charge":43,"discounted_cash":43,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":43},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nucynta Er   Tab 200mg","code_information":[{"code":"CP17744631830645377","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510023260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cefazolin    Sol","code_information":[{"code":"CP17744631829143610","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefazolin 2gm Sol","code_information":[{"code":"CP17744631829152371","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm Soln/100ml","code_information":[{"code":"CP17744631829155441","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100 Ml Sol","code_information":[{"code":"CP17744631829154254","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml D5","code_information":[{"code":"CP17744631829155999","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Dex","code_information":[{"code":"CP17744631829151296","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Dext","code_information":[{"code":"CP17744631829156922","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Shower Transfer Bench","code_information":[{"code":"CP17744631831017470","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin   Inj 1.5/300","code_information":[{"code":"CP17744631831236593","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Vancomycin 1.5g/300ml Swfi","code_information":[{"code":"CP17744631831231756","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Rollator Dura 7.5 Red","code_information":[{"code":"CP17744631830915930","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922314","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rollator Standard Weight","code_information":[{"code":"CP17744631830916416","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922314","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rollator With Seat","code_information":[{"code":"CP17744631830914032","type":"CDM"},{"code":"250","type":"RC"},{"code":"81506707161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Walker Folding W/ Wheels","code_information":[{"code":"CP17744631831300298","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601001871","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Walker Rollator Red","code_information":[{"code":"CP17744631831309104","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601001871","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830306112","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383028604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sumatriptan  Inj 6mg/0.5","code_information":[{"code":"CP17744631831089656","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323027301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Rayaldee     Cap 30mcg","code_information":[{"code":"CP17744631830872170","type":"CDM"},{"code":"250","type":"RC"},{"code":"70301100101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rytary       Cap 245mg","code_information":[{"code":"CP17744631830925929","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":245,"type":"ME"}},{"description":"Temozolomide Cap 100mg","code_information":[{"code":"CP17744631831113881","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877053914","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Xcopri       Tab 100mg","code_information":[{"code":"CP17744631831380381","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699010030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Xcopri       Tab 150mg","code_information":[{"code":"CP17744631831383589","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699015030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Xcopri       Tab 25mg","code_information":[{"code":"CP17744631831381856","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699002530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Xcopri       Tab 50mg","code_information":[{"code":"CP17744631831382347","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699005030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Delivery-shipping Charge","code_information":[{"code":"CP17744631829553778","type":"CDM"},{"code":"250","type":"RC"},{"code":"12345678910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":34,"maximum":42,"gross_charge":42,"discounted_cash":42,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":42},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alphagan P   Sol 0.15%","code_information":[{"code":"CP17744631828431306","type":"CDM"},{"code":"250","type":"RC"},{"code":"23917","type":"CPT","modifier":"705"}],"standard_charges":[{"setting":"outpatient","modifier_code":["705"],"minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Alphagan P   Sol 0.15%","code_information":[{"code":"CP17744631828439759","type":"CDM"},{"code":"250","type":"RC"},{"code":"23917","type":"CPT","modifier":"710"}],"standard_charges":[{"setting":"outpatient","modifier_code":["710"],"minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Hydrocort Ac Sup 30mg","code_information":[{"code":"CP17744631830112479","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494034212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Fluzone      Inj 2024-25","code_information":[{"code":"CP17744631829994844","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281042450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Fluorouracil Cre 0.5%","code_information":[{"code":"CP17744631829975095","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Buprenorphin Dis 20mcg/hr","code_information":[{"code":"CP17744631828970185","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742037604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Iv Saphire Admin Set 114\"","code_information":[{"code":"CP17744631830176071","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"403","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":41,"discounted_cash":41}]},{"description":"Hc Pramoxine Cre 2.5-1%","code_information":[{"code":"CP17744631830077932","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817081701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Nafcillin Inj 12gm Ns 1000ml","code_information":[{"code":"CP17744631830537890","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860011999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Transfer     Mis Bench","code_information":[{"code":"CP17744631831164648","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703018851","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fycompa      Tab 10mg","code_information":[{"code":"CP17744631830016272","type":"CDM"},{"code":"250","type":"RC"},{"code":"69616028030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fycompa      Tab 10mg","code_information":[{"code":"CP17744631830015460","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856028030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fycompa      Tab 12mg","code_information":[{"code":"CP17744631830013779","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856028230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Fycompa      Tab 4mg","code_information":[{"code":"CP17744631830010420","type":"CDM"},{"code":"250","type":"RC"},{"code":"69616027430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fycompa      Tab 4mg","code_information":[{"code":"CP17744631830011338","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856027430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fycompa      Tab 6mg","code_information":[{"code":"CP17744631830016492","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856027630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Fycompa      Tab 6mg","code_information":[{"code":"CP17744631830019624","type":"CDM"},{"code":"250","type":"RC"},{"code":"69616027630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Fycompa      Tab 8mg","code_information":[{"code":"CP17744631830018230","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856027830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Fycompa      Tab 8mg","code_information":[{"code":"CP17744631830017343","type":"CDM"},{"code":"250","type":"RC"},{"code":"69616027830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Fycompa 6mg Tabs","code_information":[{"code":"CP17744631830014501","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856027630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Drug Buster 12-16 Oz","code_information":[{"code":"CP17744631829753550","type":"CDM"},{"code":"250","type":"RC"},{"code":"99416100000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Combigan     Sol 0.2/0.5%","code_information":[{"code":"CP17744631829414706","type":"CDM"},{"code":"250","type":"RC"},{"code":"23921","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Combigan     Sol 0.2/0.5%","code_information":[{"code":"CP17744631829418228","type":"CDM"},{"code":"250","type":"RC"},{"code":"23921","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Combigan 0.2-0.5% Ophth Sol","code_information":[{"code":"CP17744631829416411","type":"CDM"},{"code":"250","type":"RC"},{"code":"23921","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Ativan       Tab 0.5mg","code_information":[{"code":"CP17744631828772780","type":"CDM"},{"code":"250","type":"RC"},{"code":"18700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Walker Adult Mis Folding","code_information":[{"code":"CP17744631831303031","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601008570","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Menostar     Dis 14mcg","code_information":[{"code":"CP17744631830426235","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419045504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Fosamax      Tab 70mg","code_information":[{"code":"CP17744631829994832","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206013501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":33,"maximum":41,"gross_charge":41,"discounted_cash":41,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":41},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Calcitonin   Spr 200/act","code_information":[{"code":"CP17744631829066580","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Calcitonin Spr 200/act (30dose","code_information":[{"code":"CP17744631829063827","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Lidocain/diphen/nystat Sus","code_information":[{"code":"CP17744631830325741","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Sus 100000","code_information":[{"code":"CP17744631830656222","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Humulin      Inj 70/30","code_information":[{"code":"CP17744631830099678","type":"CDM"},{"code":"250","type":"RC"},{"code":"28715","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Humulin 70/30 Vial","code_information":[{"code":"CP17744631830090064","type":"CDM"},{"code":"250","type":"RC"},{"code":"28715","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Humulin R    Inj U-100","code_information":[{"code":"CP17744631830093567","type":"CDM"},{"code":"250","type":"RC"},{"code":"28215","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humulin R 100 Units/ml Mdv 3ml","code_information":[{"code":"CP17744631830093130","type":"CDM"},{"code":"250","type":"RC"},{"code":"28215","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Qulipta      Tab 10mg","code_information":[{"code":"CP17744631830879093","type":"CDM"},{"code":"250","type":"RC"},{"code":"74709","type":"CPT","modifier":"530"}],"standard_charges":[{"setting":"outpatient","modifier_code":["530"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Qulipta      Tab 30mg","code_information":[{"code":"CP17744631830874882","type":"CDM"},{"code":"250","type":"RC"},{"code":"74709","type":"CPT","modifier":"630"}],"standard_charges":[{"setting":"outpatient","modifier_code":["630"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Qulipta      Tab 60mg","code_information":[{"code":"CP17744631830875859","type":"CDM"},{"code":"250","type":"RC"},{"code":"74709","type":"CPT","modifier":"430"}],"standard_charges":[{"setting":"outpatient","modifier_code":["430"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Afluria Quad Pfs Syr2022","code_information":[{"code":"CP17744631828366115","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332032203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenam 1gm/100ml Mb","code_information":[{"code":"CP17744631829797966","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenam 1gm/100ml Ns","code_information":[{"code":"CP17744631829804692","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenam 1gm/100ml Ns","code_information":[{"code":"CP17744631829806288","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenam 1gm/100ml Ns Mb+","code_information":[{"code":"CP17744631829806524","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenam 1gm/100ml Ns Mb+","code_information":[{"code":"CP17744631829805120","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenam 1gm/100ml Ns Mb+","code_information":[{"code":"CP17744631829808024","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829802396","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829802524","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829805857","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829808995","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829806385","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829804622","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829804610","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem    Inj 1gm","code_information":[{"code":"CP17744631829805124","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem 1 Gm/100 Ml Mb+","code_information":[{"code":"CP17744631829806793","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829806240","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1 Gm/50 Ml Ns","code_information":[{"code":"CP17744631829804343","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 1 Gm/50 Ml Ns","code_information":[{"code":"CP17744631829806813","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 1 Gm/50 Ml Ns","code_information":[{"code":"CP17744631829806754","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 1500mg/50 Ml Ns","code_information":[{"code":"CP17744631829802156","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1500,"type":"ME"}},{"description":"Ertapenem 1500mg/50 Ml Ns","code_information":[{"code":"CP17744631829802664","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1500,"type":"ME"}},{"description":"Ertapenem 1gm Solr","code_information":[{"code":"CP17744631829803724","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ertapenem 1gm/ 100ml","code_information":[{"code":"CP17744631829806293","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/ 100ml","code_information":[{"code":"CP17744631829809898","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/ 100ml Elj","code_information":[{"code":"CP17744631829809893","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/ 100ml El-j","code_information":[{"code":"CP17744631829804263","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/ 100ml El-j","code_information":[{"code":"CP17744631829804982","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/100ml El-j","code_information":[{"code":"CP17744631829802025","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/100ml Ns","code_information":[{"code":"CP17744631829803151","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/100ml Ns","code_information":[{"code":"CP17744631829809720","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/100ml Ns Kt","code_information":[{"code":"CP17744631829805589","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem 1gm/50ml Ns","code_information":[{"code":"CP17744631829804858","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 1gm/50ml Ns","code_information":[{"code":"CP17744631829800271","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 1gm/50ml Ns","code_information":[{"code":"CP17744631829808349","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 1gm/50ml Ns Kt","code_information":[{"code":"CP17744631829807068","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 1gram/50ml Nacl","code_information":[{"code":"CP17744631829809707","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829802735","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829807145","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829807889","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829806121","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829806219","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829803902","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829800893","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829809386","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg/100ml Elj","code_information":[{"code":"CP17744631829804138","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829804278","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500 Mg/50 Ml Ns Kt","code_information":[{"code":"CP17744631829803680","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500mg In 50ml Ns","code_information":[{"code":"CP17744631829804802","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500mg/ 50ml","code_information":[{"code":"CP17744631829807809","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500mg/ 50ml","code_information":[{"code":"CP17744631829805081","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500mg/100ml Ns","code_information":[{"code":"CP17744631829800512","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem 500mg/50ml Eld","code_information":[{"code":"CP17744631829807846","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ertapenem1gm/100ml Ns","code_information":[{"code":"CP17744631829804741","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem1gm/100ml Sod Cl 0.9%","code_information":[{"code":"CP17744631829809331","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150028220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ertapenem1gm/50ml Ns Mb+","code_information":[{"code":"CP17744631829804153","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567082010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem1gm/50ml Ns Mb+","code_information":[{"code":"CP17744631829808944","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ertapenem1gm/50ml Ns Mb+","code_information":[{"code":"CP17744631829804305","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Famciclovir  Tab 500mg","code_information":[{"code":"CP17744631829835917","type":"CDM"},{"code":"250","type":"RC"},{"code":"93811","type":"CPT","modifier":"956"}],"standard_charges":[{"setting":"outpatient","modifier_code":["956"],"minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Afluria      Inj 2024-25","code_information":[{"code":"CP17744631828362298","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332012410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Afluria Mdv 2024-2025","code_information":[{"code":"CP17744631828367666","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332012410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Afluria Mdv 2024-2025 Vial","code_information":[{"code":"CP17744631828363620","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332012410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Afluria Mdv 24-25 5 Ml Vial","code_information":[{"code":"CP17744631828360082","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332012410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tobramycin   Pow Sulfate","code_information":[{"code":"CP17744631831148296","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779031906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Invokana     Tab 300mg","code_information":[{"code":"CP17744631830159472","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458014130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Fluzone Quad Inj 2023-24","code_information":[{"code":"CP17744631829999262","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281042350","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":32,"maximum":40,"gross_charge":40,"discounted_cash":40,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":40},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Fondaparinux Inj 10/0.8ml","code_information":[{"code":"CP17744631829993025","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457058508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Altoprev     Tab 20mg Er","code_information":[{"code":"CP17744631828455348","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515062830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Altoprev     Tab 40mg Er","code_information":[{"code":"CP17744631828452720","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515062930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fanapt       Tab 6mg","code_information":[{"code":"CP17744631829841412","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068010602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Fanapt       Tab 8mg","code_information":[{"code":"CP17744631829849239","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068010802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Admelog      Inj 100u/ml","code_information":[{"code":"CP17744631828358212","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"605"}],"standard_charges":[{"setting":"outpatient","modifier_code":["605"],"minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Admelog 100 Units/ml Mdv 3ml","code_information":[{"code":"CP17744631828351553","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"605"}],"standard_charges":[{"setting":"outpatient","modifier_code":["605"],"minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Heelift Suspension Boot","code_information":[{"code":"CP17744631830077020","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin 250mg/5ml","code_information":[{"code":"CP17744631831241106","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin 50mg/ml","code_information":[{"code":"CP17744631831241061","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline 50mg/100ml Mb Ns","code_information":[{"code":"CP17744631831139170","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121164707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline 50mg/100ml Ns 0.9%","code_information":[{"code":"CP17744631831138296","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121164707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Alphagan P   Sol 0.1%","code_information":[{"code":"CP17744631828432559","type":"CDM"},{"code":"250","type":"RC"},{"code":"23932","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alphagan P 0.1% Ophth Soln","code_information":[{"code":"CP17744631828447284","type":"CDM"},{"code":"250","type":"RC"},{"code":"23932","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alphagan P   Sol 0.1%","code_information":[{"code":"CP17744631828433046","type":"CDM"},{"code":"250","type":"RC"},{"code":"23932","type":"CPT","modifier":"115"}],"standard_charges":[{"setting":"outpatient","modifier_code":["115"],"minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amikacin     Inj 500/2ml","code_information":[{"code":"CP17744631828460394","type":"CDM"},{"code":"250","type":"RC"},{"code":"70390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Alphagan P   Sol 0.1%","code_information":[{"code":"CP17744631828434687","type":"CDM"},{"code":"250","type":"RC"},{"code":"23932","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alphagan P 0.1% Soln","code_information":[{"code":"CP17744631828443520","type":"CDM"},{"code":"250","type":"RC"},{"code":"23932","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Asmanex 14   Aer 220mcg","code_information":[{"code":"CP17744631828762847","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Viread       Tab 250mg","code_information":[{"code":"CP17744631831275531","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958040601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Brimonidine  Sol 0.15%","code_information":[{"code":"CP17744631828951691","type":"CDM"},{"code":"250","type":"RC"},{"code":"82182077305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Desoximetas  Oin 0.25%","code_information":[{"code":"CP17744631829568849","type":"CDM"},{"code":"250","type":"RC"},{"code":"47204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31,"maximum":39,"gross_charge":39,"discounted_cash":39,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":39},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Afluria Quad Inj 2023-24","code_information":[{"code":"CP17744631828364268","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332042310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Afluria Quad Vial 2023 To 2024","code_information":[{"code":"CP17744631828367729","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332042310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Bromfenac    Sol 0.09% Op","code_information":[{"code":"CP17744631828959758","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383024971","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Afluria Quad Inj 2021-22","code_information":[{"code":"CP17744631828365721","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332032101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2021,"type":"EA"}},{"description":"Doxepin      Tab 6mg","code_information":[{"code":"CP17744631829737615","type":"CDM"},{"code":"250","type":"RC"},{"code":"44183010630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Nebusal      Neb 3%","code_information":[{"code":"CP17744631830546572","type":"CDM"},{"code":"250","type":"RC"},{"code":"50190014263","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Xadago       Tab 100mg","code_information":[{"code":"CP17744631831384766","type":"CDM"},{"code":"250","type":"RC"},{"code":"27505011130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Xadago       Tab 50mg","code_information":[{"code":"CP17744631831388984","type":"CDM"},{"code":"250","type":"RC"},{"code":"27505011030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Micafungin   Inj 100mg","code_information":[{"code":"CP17744631830476787","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Micafungin 100 Mg/100 Ml El-d","code_information":[{"code":"CP17744631830472934","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Micafungin 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830476272","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Micafungin 150 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830474589","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Micafungin 50 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830477134","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Rear Anti-tippers","code_information":[{"code":"CP17744631830885787","type":"CDM"},{"code":"250","type":"RC"},{"code":"89271","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trexall      Tab 7.5mg","code_information":[{"code":"CP17744631831171768","type":"CDM"},{"code":"250","type":"RC"},{"code":"51285036701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Hysingla Er  Tab 60 Mg","code_information":[{"code":"CP17744631830122204","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011027460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Temozolomide Cap 100mg","code_information":[{"code":"CP17744631831112928","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335089274","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Travoprost   Dro 0.004%","code_information":[{"code":"CP17744631831166513","type":"CDM"},{"code":"250","type":"RC"},{"code":"37896","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":38,"gross_charge":38,"discounted_cash":38,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":38},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omron 3 Seri Mis Bp Monit","code_information":[{"code":"CP17744631830689074","type":"CDM"},{"code":"250","type":"RC"},{"code":"73796071002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitro-bid    Oin 2%","code_information":[{"code":"CP17744631830569599","type":"CDM"},{"code":"250","type":"RC"},{"code":"28103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Nitro-bid 2% Ointment","code_information":[{"code":"CP17744631830561688","type":"CDM"},{"code":"250","type":"RC"},{"code":"28103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Delestrogen  Inj 20mg/ml","code_information":[{"code":"CP17744631829556939","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rytary       Cap 195mg","code_information":[{"code":"CP17744631830928966","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":195,"type":"ME"}},{"description":"Rytary Cap 48.75-195 Mg","code_information":[{"code":"CP17744631830922337","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":4875,"type":"ME"}},{"description":"Rytary Er 48.75 Mg-195 Mg Cap","code_information":[{"code":"CP17744631830926109","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":4875,"type":"ME"}},{"description":"Motegrity    Tab 1mg","code_information":[{"code":"CP17744631830504836","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092054601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Motegrity    Tab 2mg","code_information":[{"code":"CP17744631830509263","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092054701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tigecycline  Inj 50mg","code_information":[{"code":"CP17744631831120661","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline  Inj 50mg","code_information":[{"code":"CP17744631831126889","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729036468","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dorzolamide  Sol 2% Op","code_information":[{"code":"CP17744631829726822","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571014126","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Afluria Quad Mdv Vial2022","code_information":[{"code":"CP17744631828361860","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332042210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2022,"type":"EA"}},{"description":"Desmopressin Spr 0.01%","code_information":[{"code":"CP17744631829566822","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335078891","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluzone Quad Inj 2023-24","code_information":[{"code":"CP17744631829999741","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281063915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":2023,"type":"EA"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830400763","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993037083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Azopt        Sus 1% Op","code_information":[{"code":"CP17744631828810705","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758008570","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Advair Hfa   Aer 230/21","code_information":[{"code":"CP17744631828354832","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":230,"type":"EA"}},{"description":"Advair Hfa Aer 230/21 120 Inh","code_information":[{"code":"CP17744631828359290","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":230,"type":"EA"}},{"description":"Tobradex     Sus 0.3-0.1%","code_information":[{"code":"CP17744631831146244","type":"CDM"},{"code":"250","type":"RC"},{"code":"78095","type":"CPT","modifier":"325"}],"standard_charges":[{"setting":"outpatient","modifier_code":["325"],"minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Maxalt       Tab 10mg","code_information":[{"code":"CP17744631830409545","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267","type":"CPT","modifier":"18"}],"standard_charges":[{"setting":"outpatient","modifier_code":["18"],"minimum":30,"maximum":37,"gross_charge":37,"discounted_cash":37,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":37},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Imiquimod    Cre 3.75%pmp","code_information":[{"code":"CP17744631830131052","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672417409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Aerochamber  Mis  Plus","code_information":[{"code":"CP17744631828369576","type":"CDM"},{"code":"250","type":"RC"},{"code":"45631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aerochamber  Mis Mthpiece","code_information":[{"code":"CP17744631828366583","type":"CDM"},{"code":"250","type":"RC"},{"code":"4351050012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sevelam Hcl  Tab 800mg","code_information":[{"code":"CP17744631831008620","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748017326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831018226","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748017326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl 800mg (Renagel)","code_information":[{"code":"CP17744631831019421","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748017326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl 800mg Tabs","code_information":[{"code":"CP17744631831014052","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748017326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl Tab 800mg","code_information":[{"code":"CP17744631831017245","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748017326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Bath Stool With Back","code_information":[{"code":"CP17744631828846879","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999990240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829238021","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436000904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Lmx 4 Plus   Kit 4%","code_information":[{"code":"CP17744631830359090","type":"CDM"},{"code":"250","type":"RC"},{"code":"49608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobra/dexame Sus 0.3-0.1%","code_information":[{"code":"CP17744631831145844","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Elastomeric Pump100/100ml","code_information":[{"code":"CP17744631829768309","type":"CDM"},{"code":"250","type":"RC"},{"code":"61001000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Prezista     Tab 600mg","code_information":[{"code":"CP17744631830839039","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Prezista 600mg Tabs","code_information":[{"code":"CP17744631830836707","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Fosaprepitan Sol 150mg","code_information":[{"code":"CP17744631829991673","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714024801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Vashe Wound  Sol Therapy","code_information":[{"code":"CP17744631831253680","type":"CDM"},{"code":"250","type":"RC"},{"code":"51383000314","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zetonna      Aer 37mcg","code_information":[{"code":"CP17744631831394956","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515073760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":37,"type":"ME"}},{"description":"Noritate     Cre 1%","code_information":[{"code":"CP17744631830571234","type":"CDM"},{"code":"250","type":"RC"},{"code":"18752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylpr Ss  Inj 1000mg","code_information":[{"code":"CP17744631830459637","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Commode      Mis Bedside","code_information":[{"code":"CP17744631829413990","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601023572","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vios Lc Plus Mis","code_information":[{"code":"CP17744631831279543","type":"CDM"},{"code":"250","type":"RC"},{"code":"83490031067","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dextroamphet Tab 30mg","code_information":[{"code":"CP17744631829588748","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536053003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Opzelura     Cre 1.5%","code_information":[{"code":"CP17744631830691275","type":"CDM"},{"code":"250","type":"RC"},{"code":"50881000705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Zyprexa      Tab 15mg","code_information":[{"code":"CP17744631831417188","type":"CDM"},{"code":"250","type":"RC"},{"code":"24415","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Isentress    Tab 400mg","code_information":[{"code":"CP17744631830162376","type":"CDM"},{"code":"250","type":"RC"},{"code":"60227","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Isentress 400mg Tabs","code_information":[{"code":"CP17744631830162243","type":"CDM"},{"code":"250","type":"RC"},{"code":"60227","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Isentress Hd Tab 600mg","code_information":[{"code":"CP17744631830163371","type":"CDM"},{"code":"250","type":"RC"},{"code":"63080","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Veltassa     Pow 16.8gm","code_information":[{"code":"CP17744631831251280","type":"CDM"},{"code":"250","type":"RC"},{"code":"53436016830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":168,"type":"GR"}},{"description":"Veltassa     Pow 8.4gm","code_information":[{"code":"CP17744631831250935","type":"CDM"},{"code":"250","type":"RC"},{"code":"53436008430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":29,"maximum":36,"gross_charge":36,"discounted_cash":36,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":36},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29}]}],"drug_information":{"unit":84,"type":"GR"}},{"description":"Flovent  220mcg 120 Inh","code_information":[{"code":"CP17744631829968471","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Flovent Hfa  Aer 220mcg","code_information":[{"code":"CP17744631829960986","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":22,"type":"ME"}},{"description":"Doxycycl Hyc Tab 50mg","code_information":[{"code":"CP17744631829742242","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332049960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Zuplenz      Mis 4mg","code_information":[{"code":"CP17744631831411669","type":"CDM"},{"code":"250","type":"RC"},{"code":"89141044430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Afluria Quad Inj 2021-22","code_information":[{"code":"CP17744631828368874","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332042110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":2021,"type":"EA"}},{"description":"Citalopram   Sol 10mg/5ml","code_information":[{"code":"CP17744631829247128","type":"CDM"},{"code":"250","type":"RC"},{"code":"54006","type":"CPT","modifier":"258"}],"standard_charges":[{"setting":"outpatient","modifier_code":["258"],"minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Risedronate  Tab 150mg","code_information":[{"code":"CP17744631830897368","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505309702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Oxycontin    Tab 80mg Cr","code_information":[{"code":"CP17744631830721560","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011048020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Risedronate  Tab 150mg","code_information":[{"code":"CP17744631830899875","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762040603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Risedronate  Tab 150mg","code_information":[{"code":"CP17744631830897743","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862087003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Risedronate  Tab 150mg","code_information":[{"code":"CP17744631830896336","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862087011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Tradjenta    Tab 5mg","code_information":[{"code":"CP17744631831159060","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828946981","type":"CDM"},{"code":"250","type":"RC"},{"code":"82182045505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Collanex     Pow","code_information":[{"code":"CP17744631829404364","type":"CDM"},{"code":"250","type":"RC"},{"code":"58980075405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Loteprednol  Sus 0.2%","code_information":[{"code":"CP17744631830373891","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485065305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Tretinoin    Cre 0.05%","code_information":[{"code":"CP17744631831172409","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714024902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bepotastine  Dro 1.5%","code_information":[{"code":"CP17744631828865798","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bepotastine  Dro 1.5% Op","code_information":[{"code":"CP17744631828868890","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Spr 20mg/act","code_information":[{"code":"CP17744631831088704","type":"CDM"},{"code":"250","type":"RC"},{"code":"78165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828946294","type":"CDM"},{"code":"250","type":"RC"},{"code":"83214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Toilet Frame Mis Saefty","code_information":[{"code":"CP17744631831148935","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601013580","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desferal     Inj 500mg","code_information":[{"code":"CP17744631829568616","type":"CDM"},{"code":"250","type":"RC"},{"code":"78046","type":"CPT","modifier":"791"}],"standard_charges":[{"setting":"outpatient","modifier_code":["791"],"minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Toilet Seat W/arms Raised","code_information":[{"code":"CP17744631831144935","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601065850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desmopressin Inj 4mcg/ml","code_information":[{"code":"CP17744631829564195","type":"CDM"},{"code":"250","type":"RC"},{"code":"70350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Aprepitant   Cap 80mg","code_information":[{"code":"CP17744631828735747","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462058458","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Rifabutin    Cap 150mg","code_information":[{"code":"CP17744631830891278","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954004110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":28,"maximum":35,"gross_charge":35,"discounted_cash":35,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":35},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Trientine    Cap 250mg","code_information":[{"code":"CP17744631831181290","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722068301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Trientine    Cap 250mg","code_information":[{"code":"CP17744631831184643","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571081001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Gemtesa      Tab 75mg","code_information":[{"code":"CP17744631830023903","type":"CDM"},{"code":"250","type":"RC"},{"code":"73336007530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Albendazole  Tab 200mg","code_information":[{"code":"CP17744631828374926","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205005108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Azopt        Sus 1% Op","code_information":[{"code":"CP17744631828812637","type":"CDM"},{"code":"250","type":"RC"},{"code":"65027","type":"CPT","modifier":"510"}],"standard_charges":[{"setting":"outpatient","modifier_code":["510"],"minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rybelsus     Tab 14mg","code_information":[{"code":"CP17744631830924384","type":"CDM"},{"code":"250","type":"RC"},{"code":"16943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Rybelsus     Tab 3mg","code_information":[{"code":"CP17744631830925864","type":"CDM"},{"code":"250","type":"RC"},{"code":"16943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rybelsus     Tab 7mg","code_information":[{"code":"CP17744631830925519","type":"CDM"},{"code":"250","type":"RC"},{"code":"16943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Flurazepam   Cap 15mg","code_information":[{"code":"CP17744631829986396","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135073630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Restoril     Cap 7.5mg","code_information":[{"code":"CP17744631830899937","type":"CDM"},{"code":"250","type":"RC"},{"code":"40699","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Glatiramer   Inj 20mg/ml","code_information":[{"code":"CP17744631830039069","type":"CDM"},{"code":"250","type":"RC"},{"code":"37869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Veltassa     Pow 25.2gm","code_information":[{"code":"CP17744631831254162","type":"CDM"},{"code":"250","type":"RC"},{"code":"53436025230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":252,"type":"GR"}},{"description":"Savella      Tab 100mg","code_information":[{"code":"CP17744631830998615","type":"CDM"},{"code":"250","type":"RC"},{"code":"45615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ibsrela      Tab 50mg","code_information":[{"code":"CP17744631830120982","type":"CDM"},{"code":"250","type":"RC"},{"code":"73154005060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829435665","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Micafungin   Inj 100mg","code_information":[{"code":"CP17744631830472616","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505612006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Micafungin 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830477601","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505612006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hydrocort    Oin 2.5%","code_information":[{"code":"CP17744631830106976","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802001405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydrocortisone 2.5% Oint","code_information":[{"code":"CP17744631830114078","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802001405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Retacrit     Inj 3000unit","code_information":[{"code":"CP17744631830896866","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":3000,"type":"UN"}},{"description":"Retacrit     Inj 3000unit","code_information":[{"code":"CP17744631830894727","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"610"}],"standard_charges":[{"setting":"outpatient","modifier_code":["610"],"minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":3000,"type":"UN"}},{"description":"Fentanyl     Dis 37.5mcg","code_information":[{"code":"CP17744631829858010","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Buprenorphin Dis 20mcg/hr","code_information":[{"code":"CP17744631828970044","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238120502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Opaque/knee  Mis X-large","code_information":[{"code":"CP17744631830696697","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664015135","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ins Degl Flx Inj 100unit","code_information":[{"code":"CP17744631830143696","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070040315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Degludec 100 Un/ml Pen","code_information":[{"code":"CP17744631830148400","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070040315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Fml Forte    Sus 0.25% Op","code_information":[{"code":"CP17744631829992228","type":"CDM"},{"code":"250","type":"RC"},{"code":"11980022805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Fml Forte 0.25% Susp","code_information":[{"code":"CP17744631829992187","type":"CDM"},{"code":"250","type":"RC"},{"code":"11980022805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Micafungin 150mg/100ml","code_information":[{"code":"CP17744631830479148","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021019111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Sympazan     Mis 10mg","code_information":[{"code":"CP17744631831089287","type":"CDM"},{"code":"250","type":"RC"},{"code":"10094021060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fosfomycin   Pow 3gm","code_information":[{"code":"CP17744631829994348","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877074957","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":27,"maximum":34,"gross_charge":34,"discounted_cash":34,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":34},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Benztropine  Inj 1mg/ml","code_information":[{"code":"CP17744631828862541","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Benztropine 1mg/ml Amp","code_information":[{"code":"CP17744631828868591","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Pramipexole  Tab 1.5mg Er","code_information":[{"code":"CP17744631830803141","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370025311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830789382","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238147606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Combipatch   Dis","code_information":[{"code":"CP17744631829419503","type":"CDM"},{"code":"250","type":"RC"},{"code":"68968051408","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Combipatch   Dis","code_information":[{"code":"CP17744631829412104","type":"CDM"},{"code":"250","type":"RC"},{"code":"68968052508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobradex     Sus 0.3-0.1%","code_information":[{"code":"CP17744631831143413","type":"CDM"},{"code":"250","type":"RC"},{"code":"65064","type":"CPT","modifier":"725"}],"standard_charges":[{"setting":"outpatient","modifier_code":["725"],"minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Nitrofurantn Sus 50mg/5ml","code_information":[{"code":"CP17744631830564791","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571088806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nitrofuranto Sus 50mg/5ml","code_information":[{"code":"CP17744631830568994","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571088806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ciprodex     Sus 0.3-0.1%","code_information":[{"code":"CP17744631829232522","type":"CDM"},{"code":"250","type":"RC"},{"code":"78079","type":"CPT","modifier":"975"}],"standard_charges":[{"setting":"outpatient","modifier_code":["975"],"minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Deferiprone  Tab 500mg","code_information":[{"code":"CP17744631829554401","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672419601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Epogen       Inj 2000/ml","code_information":[{"code":"CP17744631829790104","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513012610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2000,"type":"EA"}},{"description":"Droxidopa    Cap 300mg","code_information":[{"code":"CP17744631829756549","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722001090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lido/prilocn Kit 2.5-2.5%","code_information":[{"code":"CP17744631830324792","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tigan        Inj 100mg/ml","code_information":[{"code":"CP17744631831129584","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023011925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Vigamox      Dro 0.5%","code_information":[{"code":"CP17744631831275547","type":"CDM"},{"code":"250","type":"RC"},{"code":"82667070003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Office & Maintenance Supp","code_information":[{"code":"CP17744631830661214","type":"CDM"},{"code":"250","type":"RC"},{"code":"66666666666","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Safety Hypodermic Ndl Ut","code_information":[{"code":"CP17744631830923535","type":"CDM"},{"code":"250","type":"RC"},{"code":"66666666666","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Meropenem 2g In 100ml Ns","code_information":[{"code":"CP17744631830427550","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567040206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 2g/100ml Elj","code_information":[{"code":"CP17744631830428342","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567040206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 2gm/100ml Ns Mb+","code_information":[{"code":"CP17744631830426993","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567040206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Sunosi       Tab 150mg","code_information":[{"code":"CP17744631831086944","type":"CDM"},{"code":"250","type":"RC"},{"code":"81968035101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Sunosi       Tab 75mg","code_information":[{"code":"CP17744631831086792","type":"CDM"},{"code":"250","type":"RC"},{"code":"81968035001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Primaxin Iv  Inj 500mg","code_information":[{"code":"CP17744631830835618","type":"CDM"},{"code":"250","type":"RC"},{"code":"63516","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Betimol      Sol 0.5%","code_information":[{"code":"CP17744631828877596","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584000205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Betoptic S 0.25% Ophth Susp","code_information":[{"code":"CP17744631828875903","type":"CDM"},{"code":"250","type":"RC"},{"code":"65024","type":"CPT","modifier":"610"}],"standard_charges":[{"setting":"outpatient","modifier_code":["610"],"minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Welchol      Pak 3.75gm","code_information":[{"code":"CP17744631831374740","type":"CDM"},{"code":"250","type":"RC"},{"code":"71308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Tens System Dlx Agf3x Bx","code_information":[{"code":"CP17744631831119507","type":"CDM"},{"code":"250","type":"RC"},{"code":"82238310450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ziprasidone  Inj 20mg","code_information":[{"code":"CP17744631831409163","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598084858","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":33,"gross_charge":33,"discounted_cash":33,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":33},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Blood Prssre Kit Monitor","code_information":[{"code":"CP17744631828937871","type":"CDM"},{"code":"250","type":"RC"},{"code":"87701042996","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wrist Blood Pressure Monito--k","code_information":[{"code":"CP17744631831386012","type":"CDM"},{"code":"250","type":"RC"},{"code":"87701042996","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pirfenidone  Tab 534mg","code_information":[{"code":"CP17744631830784380","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385092590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":534,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831093070","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668056830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vuity        Sol 1.25% Op","code_information":[{"code":"CP17744631831305483","type":"CDM"},{"code":"250","type":"RC"},{"code":"74709","type":"CPT","modifier":"804"}],"standard_charges":[{"setting":"outpatient","modifier_code":["804"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Levemir      Inj Flexpen","code_information":[{"code":"CP17744631830299972","type":"CDM"},{"code":"250","type":"RC"},{"code":"16964","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levemir 100 Unit/ml Flxpen 3ml","code_information":[{"code":"CP17744631830292072","type":"CDM"},{"code":"250","type":"RC"},{"code":"16964","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glar Inj 100u/ml","code_information":[{"code":"CP17744631830144467","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glar Solostar 100u/ml","code_information":[{"code":"CP17744631830147996","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glargine 100 Un/ml Pen","code_information":[{"code":"CP17744631830144168","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Rybelsus     Tab 14mg","code_information":[{"code":"CP17744631830927212","type":"CDM"},{"code":"250","type":"RC"},{"code":"16943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Rybelsus     Tab 3mg","code_information":[{"code":"CP17744631830926791","type":"CDM"},{"code":"250","type":"RC"},{"code":"16943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rybelsus     Tab 7mg","code_information":[{"code":"CP17744631830925641","type":"CDM"},{"code":"250","type":"RC"},{"code":"16943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Cortifoam    Aer 90mg","code_information":[{"code":"CP17744631829427598","type":"CDM"},{"code":"250","type":"RC"},{"code":"37683","type":"CPT","modifier":"15"}],"standard_charges":[{"setting":"outpatient","modifier_code":["15"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Tresiba      Inj 100unit","code_information":[{"code":"CP17744631831178702","type":"CDM"},{"code":"250","type":"RC"},{"code":"16926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Tresiba 100 Units/ml Mdv 10ml","code_information":[{"code":"CP17744631831174569","type":"CDM"},{"code":"250","type":"RC"},{"code":"16926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Pred Forte   Sus 1% Op","code_information":[{"code":"CP17744631830815988","type":"CDM"},{"code":"250","type":"RC"},{"code":"11980018005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pred Mild    Sus 0.12% Op","code_information":[{"code":"CP17744631830815573","type":"CDM"},{"code":"250","type":"RC"},{"code":"11980017405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Pred-g       Sus Op","code_information":[{"code":"CP17744631830811100","type":"CDM"},{"code":"250","type":"RC"},{"code":"23010","type":"CPT","modifier":"605"}],"standard_charges":[{"setting":"outpatient","modifier_code":["605"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 37.5mcg","code_information":[{"code":"CP17744631829850416","type":"CDM"},{"code":"250","type":"RC"},{"code":"40690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Exforgeh/10- Tab 320-25","code_information":[{"code":"CP17744631829838211","type":"CDM"},{"code":"250","type":"RC"},{"code":"78056","type":"CPT","modifier":"315"}],"standard_charges":[{"setting":"outpatient","modifier_code":["315"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":320,"type":"EA"}},{"description":"Trifluridine Sol 1% Op","code_information":[{"code":"CP17744631831197768","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fanapt       Pak","code_information":[{"code":"CP17744631829845268","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068011304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fanapt       Tab 1mg","code_information":[{"code":"CP17744631829846574","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068010102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fanapt       Tab 2mg","code_information":[{"code":"CP17744631829844977","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068010202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Fanapt       Tab 4mg","code_information":[{"code":"CP17744631829843693","type":"CDM"},{"code":"250","type":"RC"},{"code":"43068010402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Brimonidine  Sol 0.1%","code_information":[{"code":"CP17744631828958399","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505057701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ciclopirox   Cre 0.77%","code_information":[{"code":"CP17744631829229260","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462029792","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Humalog 100 Units/ml Kwpn 3ml","code_information":[{"code":"CP17744631830080480","type":"CDM"},{"code":"250","type":"RC"},{"code":"28799","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog 100unit/ml Kwikpen","code_information":[{"code":"CP17744631830080603","type":"CDM"},{"code":"250","type":"RC"},{"code":"28799","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog Kwik Inj 100/ml","code_information":[{"code":"CP17744631830086155","type":"CDM"},{"code":"250","type":"RC"},{"code":"28799","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Qnasl        Aer 80mcg","code_information":[{"code":"CP17744631830860820","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310041012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bedside Handrail","code_information":[{"code":"CP17744631828857037","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601003570","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxy 100     Inj 100mg","code_information":[{"code":"CP17744631829736054","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323013011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxy 100mg Solr","code_information":[{"code":"CP17744631829731480","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323013011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cipro Hc     Sus Otic","code_information":[{"code":"CP17744631829237983","type":"CDM"},{"code":"250","type":"RC"},{"code":"65853","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":26,"maximum":32,"gross_charge":32,"discounted_cash":32,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":32},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humidifier   Mis Cool Mst","code_information":[{"code":"CP17744631830082556","type":"CDM"},{"code":"250","type":"RC"},{"code":"28785023100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aztreonam    Inj 1gm","code_information":[{"code":"CP17744631828819486","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Aztreonam 1gm/100ml Ns","code_information":[{"code":"CP17744631828816093","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323040120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cobenfy      Cap 50-20mg","code_information":[{"code":"CP17744631829391867","type":"CDM"},{"code":"250","type":"RC"},{"code":"30050","type":"CPT","modifier":"60"}],"standard_charges":[{"setting":"outpatient","modifier_code":["60"],"minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Betimol      Sol 0.5%","code_information":[{"code":"CP17744631828873280","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584000215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Onfi         Tab 10mg","code_information":[{"code":"CP17744631830699665","type":"CDM"},{"code":"250","type":"RC"},{"code":"67386031401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Onfi 10mg Tabs","code_information":[{"code":"CP17744631830692319","type":"CDM"},{"code":"250","type":"RC"},{"code":"67386031401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Buprenorphin Dis 15mcg/hr","code_information":[{"code":"CP17744631828977446","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858058640","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Buprenorphin Dis 5mcg/hr","code_information":[{"code":"CP17744631828980631","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742037204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Buprenorphine 15mcg/hr Patch","code_information":[{"code":"CP17744631828986717","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858058640","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Iv Sub-q Hydration Kit","code_information":[{"code":"CP17744631830170786","type":"CDM"},{"code":"250","type":"RC"},{"code":"22406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Abiraterone  Tab 500mg","code_information":[{"code":"CP17744631828140741","type":"CDM"},{"code":"250","type":"RC"},{"code":"82293000210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Abiraterone  Tab 500mg","code_information":[{"code":"CP17744631828144895","type":"CDM"},{"code":"250","type":"RC"},{"code":"71921017706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Abiraterone  Tab 500mg","code_information":[{"code":"CP17744631828147167","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505476406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Brilinta     Tab 90mg","code_information":[{"code":"CP17744631828949424","type":"CDM"},{"code":"250","type":"RC"},{"code":"18607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Hydrocort    Cre 2.5%","code_information":[{"code":"CP17744631830102921","type":"CDM"},{"code":"250","type":"RC"},{"code":"31601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Fondaparinux Inj 2.5/0.5","code_information":[{"code":"CP17744631829995429","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828967101","type":"CDM"},{"code":"250","type":"RC"},{"code":"48797","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metaxalone   Tab 400mg","code_information":[{"code":"CP17744631830438976","type":"CDM"},{"code":"250","type":"RC"},{"code":"11517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Creon        Cap 12000unt","code_information":[{"code":"CP17744631829420552","type":"CDM"},{"code":"250","type":"RC"},{"code":"32121","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":12000,"type":"EA"}},{"description":"Creon 12000 Unit Caps","code_information":[{"code":"CP17744631829438447","type":"CDM"},{"code":"250","type":"RC"},{"code":"32121","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":12000,"type":"UN"}},{"description":"Bacitracin   Oin Op","code_information":[{"code":"CP17744631828827450","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Myrbetriq    Tab 50mg","code_information":[{"code":"CP17744631830539157","type":"CDM"},{"code":"250","type":"RC"},{"code":"46926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Efavir/lamiv Tab Tenofovi","code_information":[{"code":"CP17744631829769962","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385092830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Percocet     Tab 5-325mg","code_information":[{"code":"CP17744631830759882","type":"CDM"},{"code":"250","type":"RC"},{"code":"63481062370","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Humalog      Inj 100/ml","code_information":[{"code":"CP17744631830088823","type":"CDM"},{"code":"250","type":"RC"},{"code":"27516","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humalog Car 100 Units/ml 3ml","code_information":[{"code":"CP17744631830082076","type":"CDM"},{"code":"250","type":"RC"},{"code":"27516","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog Cartridge 100unit/ml","code_information":[{"code":"CP17744631830083723","type":"CDM"},{"code":"250","type":"RC"},{"code":"27516","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Movantik     Tab 25mg","code_information":[{"code":"CP17744631830516827","type":"CDM"},{"code":"250","type":"RC"},{"code":"82625880201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":25,"maximum":31,"gross_charge":31,"discounted_cash":31,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":31},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Betimol      Sol 0.5%","code_information":[{"code":"CP17744631828876542","type":"CDM"},{"code":"250","type":"RC"},{"code":"76478000205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fentanyl     Dis 75mcg/hr","code_information":[{"code":"CP17744631829855517","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Sub-q Hydrtn Kit 24gx6mm","code_information":[{"code":"CP17744631831074844","type":"CDM"},{"code":"250","type":"RC"},{"code":"22406000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefepime     Inj 2gm","code_information":[{"code":"CP17744631829164330","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829163832","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2g/100ml Ns","code_information":[{"code":"CP17744631829161398","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/100ml Nsmb+","code_information":[{"code":"CP17744631829163276","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Estradiol    Dis 0.05mg","code_information":[{"code":"CP17744631829816674","type":"CDM"},{"code":"250","type":"RC"},{"code":"37833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Meropenem    Inj 1gm","code_information":[{"code":"CP17744631830421772","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1 Gm In 100 Ml Ns","code_information":[{"code":"CP17744631830421489","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1 Gm In 50 Ml Ns","code_information":[{"code":"CP17744631830424908","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1 Gm/100 Ml Ns","code_information":[{"code":"CP17744631830426888","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1 Gm/50 Ml Ns","code_information":[{"code":"CP17744631830422902","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1 Gm/50 Ml Ns Mb+","code_information":[{"code":"CP17744631830426779","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1g/100ml Elj","code_information":[{"code":"CP17744631830421853","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1gm 50ml Ns Mb","code_information":[{"code":"CP17744631830421650","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1gm/ 50ml Ns","code_information":[{"code":"CP17744631830427551","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1gm/100ml Ns Mb+","code_information":[{"code":"CP17744631830426880","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1gm/50ml Ns Kt","code_information":[{"code":"CP17744631830421401","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1gram/100ml Ns Mb+","code_information":[{"code":"CP17744631830421764","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 2g In 100ml Ns","code_information":[{"code":"CP17744631830420083","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 2g/100ml Elj","code_information":[{"code":"CP17744631830422296","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 2g/100ml Ns","code_information":[{"code":"CP17744631830420714","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 2g/250ml Ns","code_information":[{"code":"CP17744631830421387","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 2gm/100ml Kit","code_information":[{"code":"CP17744631830422099","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Abdominal Binder","code_information":[{"code":"CP17744631828117295","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999660625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Padded Elbow Support","code_information":[{"code":"CP17744631830722693","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999993701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hemady       Tab 20mg","code_information":[{"code":"CP17744631830070888","type":"CDM"},{"code":"250","type":"RC"},{"code":"82111095501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Imipen/cilastin 1gm / 250ml Ns","code_information":[{"code":"CP17744631830136821","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Imipene/cilast 750mg/250ml Ns","code_information":[{"code":"CP17744631830133025","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Imipenem/cil Inj 500mg","code_information":[{"code":"CP17744631830135916","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Imipenem/cilast 500mg/100ml Ns","code_information":[{"code":"CP17744631830132448","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nova Cushion Mis Seat","code_information":[{"code":"CP17744631830577517","type":"CDM"},{"code":"250","type":"RC"},{"code":"52308026318","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sps          Sus 15gm/60","code_information":[{"code":"CP17744631831067616","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Sps 15gm/60ml Susp","code_information":[{"code":"CP17744631831069073","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Blood Press  Mis Monitor","code_information":[{"code":"CP17744631828934868","type":"CDM"},{"code":"250","type":"RC"},{"code":"82891037200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Difluprednat Emu 0.05%","code_information":[{"code":"CP17744631829606435","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097034135","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefepime 2gm/50ml Dex","code_information":[{"code":"CP17744631829175883","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime/dex Inj 2gm","code_information":[{"code":"CP17744631829171603","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime/dextrose 2gm","code_information":[{"code":"CP17744631829175487","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Bed Wedge 10\"","code_information":[{"code":"CP17744631828857286","type":"CDM"},{"code":"250","type":"RC"},{"code":"54756041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Astagraf Xl  Cap 5mg","code_information":[{"code":"CP17744631828773304","type":"CDM"},{"code":"250","type":"RC"},{"code":"46906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Azactam      Inj 1gm","code_information":[{"code":"CP17744631828802183","type":"CDM"},{"code":"250","type":"RC"},{"code":"32560","type":"CPT","modifier":"16"}],"standard_charges":[{"setting":"outpatient","modifier_code":["16"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Azactam  2gm/100ml Ns","code_information":[{"code":"CP17744631828801835","type":"CDM"},{"code":"250","type":"RC"},{"code":"32560","type":"CPT","modifier":"16"}],"standard_charges":[{"setting":"outpatient","modifier_code":["16"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Aztreonam 1gm/100ml Ns","code_information":[{"code":"CP17744631828818792","type":"CDM"},{"code":"250","type":"RC"},{"code":"32560","type":"CPT","modifier":"16"}],"standard_charges":[{"setting":"outpatient","modifier_code":["16"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Pyridoxine   Inj 100mg/ml","code_information":[{"code":"CP17744631830858716","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323018001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ins Lispro Protamine 75/25 Pen","code_information":[{"code":"CP17744631830140844","type":"CDM"},{"code":"250","type":"RC"},{"code":"28233","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Insulin Lisp Inj Junior","code_information":[{"code":"CP17744631830142064","type":"CDM"},{"code":"250","type":"RC"},{"code":"27752","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Lisp Inj Protamin","code_information":[{"code":"CP17744631830141214","type":"CDM"},{"code":"250","type":"RC"},{"code":"28233","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Lispro 75/25 Pen 3 Ml","code_information":[{"code":"CP17744631830146026","type":"CDM"},{"code":"250","type":"RC"},{"code":"28233","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Insulin Lispro Jr 100 Un/mlpen","code_information":[{"code":"CP17744631830141716","type":"CDM"},{"code":"250","type":"RC"},{"code":"27752","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insulin Lispro Mix 75-25 Kwkpn","code_information":[{"code":"CP17744631830147740","type":"CDM"},{"code":"250","type":"RC"},{"code":"28233","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Lokelma      Pak 10gm","code_information":[{"code":"CP17744631830351002","type":"CDM"},{"code":"250","type":"RC"},{"code":"31011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Lokelma      Pak 5gm","code_information":[{"code":"CP17744631830354288","type":"CDM"},{"code":"250","type":"RC"},{"code":"31011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Neupro       Dis 1mg/24hr","code_information":[{"code":"CP17744631830553508","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Neupro       Dis 2mg/24hr","code_information":[{"code":"CP17744631830552802","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Neupro       Dis 3mg/24hr","code_information":[{"code":"CP17744631830554597","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Neupro       Dis 6mg/24hr","code_information":[{"code":"CP17744631830556538","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Neupro       Dis 8mg/24hr","code_information":[{"code":"CP17744631830554727","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474080603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Betimol      Sol 0.25%","code_information":[{"code":"CP17744631828870475","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584000105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Lid 4%/ssd 1%/nyst/ Zno 20","code_information":[{"code":"CP17744631830323845","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328002430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Cre 4%","code_information":[{"code":"CP17744631830331204","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328002430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Penicillamin Tab 250mg","code_information":[{"code":"CP17744631830749141","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748015301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Zinc /Vit A&d/lidocaine/emolle","code_information":[{"code":"CP17744631831393698","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328002430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":24,"maximum":30,"gross_charge":30,"discounted_cash":30,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":30},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxy 100     Inj 100mg","code_information":[{"code":"CP17744631829737169","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323013013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tralement    Inj","code_information":[{"code":"CP17744631831155949","type":"CDM"},{"code":"250","type":"RC"},{"code":"51793","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Viberzi      Tab 100mg","code_information":[{"code":"CP17744631831265127","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874010060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Viberzi 100mg Tabs","code_information":[{"code":"CP17744631831268407","type":"CDM"},{"code":"250","type":"RC"},{"code":"61874010060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Betimol      Sol 0.5%","code_information":[{"code":"CP17744631828878158","type":"CDM"},{"code":"250","type":"RC"},{"code":"76478000215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Octreotide   Inj 1000mcg","code_information":[{"code":"CP17744631830655398","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323037905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Lidocaine    Inj 1%","code_information":[{"code":"CP17744631830334914","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bella/opium  Sup 16.2-60","code_information":[{"code":"CP17744631828853010","type":"CDM"},{"code":"250","type":"RC"},{"code":"57470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Itraconazole Pow","code_information":[{"code":"CP17744631830171216","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779275903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Creon        Cap 12000unt","code_information":[{"code":"CP17744631829422385","type":"CDM"},{"code":"250","type":"RC"},{"code":"32121","type":"CPT","modifier":"207"}],"standard_charges":[{"setting":"outpatient","modifier_code":["207"],"minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":12000,"type":"EA"}},{"description":"Creon 12000 Unit Caps","code_information":[{"code":"CP17744631829436315","type":"CDM"},{"code":"250","type":"RC"},{"code":"32121","type":"CPT","modifier":"207"}],"standard_charges":[{"setting":"outpatient","modifier_code":["207"],"minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":12000,"type":"UN"}},{"description":"Fentanyl     Dis 12mcg/hr","code_information":[{"code":"CP17744631829853778","type":"CDM"},{"code":"250","type":"RC"},{"code":"40691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830400758","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457088799","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Valganciclov Tab 450mg","code_information":[{"code":"CP17744631831227445","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111076260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Bp Monitor   Mis","code_information":[{"code":"CP17744631828947319","type":"CDM"},{"code":"250","type":"RC"},{"code":"93764060158","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Cre 5%","code_information":[{"code":"CP17744631828334701","type":"CDM"},{"code":"250","type":"RC"},{"code":"93363","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dasatinib    Tab 20mg","code_information":[{"code":"CP17744631829546890","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505362806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nexlizet     Tab 180/10mg","code_information":[{"code":"CP17744631830550325","type":"CDM"},{"code":"250","type":"RC"},{"code":"72426081803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Selzentry 300mg Tabs","code_information":[{"code":"CP17744631831008296","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702022418","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Dapto 275 Mg/50 Ml Ns El-d","code_information":[{"code":"CP17744631829478432","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":275,"type":"ME"}},{"description":"Dapto 470mg/50ml Ns","code_information":[{"code":"CP17744631829478115","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":470,"type":"ME"}},{"description":"Dapto 715 Mg/50 Ml Ns El-d","code_information":[{"code":"CP17744631829471214","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":715,"type":"ME"}},{"description":"Dapto 720 Mg/50 Ml Ns El-d","code_information":[{"code":"CP17744631829472806","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":720,"type":"ME"}},{"description":"Dapto 900/100","code_information":[{"code":"CP17744631829476564","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Daptomy 500mg/50ml Eld","code_information":[{"code":"CP17744631829484968","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829487571","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829485839","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829488643","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829484843","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829484487","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729043505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829484169","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097080737","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829480521","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829485269","type":"CDM"},{"code":"250","type":"RC"},{"code":"70301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin   Inj 500mg","code_information":[{"code":"CP17744631829483629","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin  408 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829485183","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":408,"type":"ME"}},{"description":"Daptomycin 1,000mg In 100ml Ns","code_information":[{"code":"CP17744631829482399","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,000mg In 100ml Ns","code_information":[{"code":"CP17744631829480380","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,000mg In 50ml Ns","code_information":[{"code":"CP17744631829487038","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,000mg/100ml Ns","code_information":[{"code":"CP17744631829484165","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,000mg/100ml Ns","code_information":[{"code":"CP17744631829489684","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,000mg/100ml Ns","code_information":[{"code":"CP17744631829484553","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,000mg/100ml Ns","code_information":[{"code":"CP17744631829489776","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,000mg/50ml Ns","code_information":[{"code":"CP17744631829481600","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1,100mg In 100ml Ns","code_information":[{"code":"CP17744631829484022","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1100,"type":"ME"}},{"description":"Daptomycin 1,100mg/100ml Ns","code_information":[{"code":"CP17744631829486840","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1100,"type":"ME"}},{"description":"Daptomycin 1,170mg In 100ml Ns","code_information":[{"code":"CP17744631829485666","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1170,"type":"ME"}},{"description":"Daptomycin 1,200mg In 100ml Ns","code_information":[{"code":"CP17744631829482792","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Daptomycin 1,250mg/100ml Ns","code_information":[{"code":"CP17744631829486587","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Daptomycin 1,250mg/100ml Ns","code_information":[{"code":"CP17744631829487392","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Daptomycin 1,300mg In 100ml Ns","code_information":[{"code":"CP17744631829483369","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1300,"type":"ME"}},{"description":"Daptomycin 1,300mg In 100ml Ns","code_information":[{"code":"CP17744631829486063","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1300,"type":"ME"}},{"description":"Daptomycin 1000mg/100ml Ns","code_information":[{"code":"CP17744631829488455","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Daptomycin 1020 Mg/50ml Ns","code_information":[{"code":"CP17744631829485498","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1020,"type":"ME"}},{"description":"Daptomycin 1050 Mg In 100ml Ns","code_information":[{"code":"CP17744631829489296","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1050,"type":"ME"}},{"description":"Daptomycin 1050 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829482600","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1050,"type":"ME"}},{"description":"Daptomycin 1050mg/100ml Ns Kit","code_information":[{"code":"CP17744631829480507","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1050,"type":"ME"}},{"description":"Daptomycin 1050mg/100ml Ns Kit","code_information":[{"code":"CP17744631829489412","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1050,"type":"ME"}},{"description":"Daptomycin 1500mg/100ml Ns","code_information":[{"code":"CP17744631829485690","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1500,"type":"ME"}},{"description":"Daptomycin 200mg In 100ml Ns","code_information":[{"code":"CP17744631829487098","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Daptomycin 200mg/50ml","code_information":[{"code":"CP17744631829485294","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Daptomycin 235mg/50 Ml Ns","code_information":[{"code":"CP17744631829489919","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":235,"type":"ME"}},{"description":"Daptomycin 240mg/50 Ml Ns","code_information":[{"code":"CP17744631829482341","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Daptomycin 250 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829483435","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Daptomycin 250 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829488162","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Daptomycin 250 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829482019","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Daptomycin 250 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829486913","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Daptomycin 250 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829482894","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Daptomycin 270mg/50ml Ns Kt","code_information":[{"code":"CP17744631829485511","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":270,"type":"ME"}},{"description":"Daptomycin 280mg/50ml","code_information":[{"code":"CP17744631829488373","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":280,"type":"ME"}},{"description":"Daptomycin 290mg/50ml","code_information":[{"code":"CP17744631829486580","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":290,"type":"ME"}},{"description":"Daptomycin 300 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829495404","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 300 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829490737","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 300 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829497082","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 300 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829494518","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 300mg/50ml","code_information":[{"code":"CP17744631829496008","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 300mg/50ml Ns El-d","code_information":[{"code":"CP17744631829499838","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 330 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829497838","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Daptomycin 336 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829492792","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":336,"type":"ME"}},{"description":"Daptomycin 337mg/100 Ml Ns","code_information":[{"code":"CP17744631829493717","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":337,"type":"ME"}},{"description":"Daptomycin 338mg In 50ml Ns","code_information":[{"code":"CP17744631829493414","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":338,"type":"ME"}},{"description":"Daptomycin 350 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829492019","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829497166","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829497774","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829497892","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350mg In 50ml Ns","code_information":[{"code":"CP17744631829498222","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350mg/100ml Ns","code_information":[{"code":"CP17744631829497686","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350mg/50ml Ns","code_information":[{"code":"CP17744631829495152","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350mg/50ml Ns","code_information":[{"code":"CP17744631829490912","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 350mg/50ml Ns El-d","code_information":[{"code":"CP17744631829490376","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 352.8 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829499199","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":3528,"type":"ME"}},{"description":"Daptomycin 360mg/100ml Ns","code_information":[{"code":"CP17744631829495581","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Daptomycin 360mg/50ml Ns","code_information":[{"code":"CP17744631829499971","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Daptomycin 364mg/50ml Ns","code_information":[{"code":"CP17744631829490920","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":364,"type":"ME"}},{"description":"Daptomycin 370mg/50ml","code_information":[{"code":"CP17744631829493217","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":370,"type":"ME"}},{"description":"Daptomycin 375mg / 100 Ml Ns","code_information":[{"code":"CP17744631829490342","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Daptomycin 375mg / 50 Ml Ns","code_information":[{"code":"CP17744631829492949","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Daptomycin 375mg In 50ml Ns","code_information":[{"code":"CP17744631829495132","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Daptomycin 380mg / 50ml Ns","code_information":[{"code":"CP17744631829492998","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":380,"type":"ME"}},{"description":"Daptomycin 380mg / 50ml Ns","code_information":[{"code":"CP17744631829497391","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":380,"type":"ME"}},{"description":"Daptomycin 380mg/50ml Ns","code_information":[{"code":"CP17744631829498023","type":"CDM"},{"code":"250","type":"RC"},{"code":"40901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":380,"type":"ME"}},{"description":"Daptomycin 385mg / 50ml Ns","code_information":[{"code":"CP17744631829490428","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":385,"type":"ME"}},{"description":"Daptomycin 390 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829492410","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":390,"type":"ME"}},{"description":"Daptomycin 395 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829492628","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":395,"type":"ME"}},{"description":"Daptomycin 400 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829497266","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829494615","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg In 100ml Ns","code_information":[{"code":"CP17744631829496671","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg In 100ml Ns","code_information":[{"code":"CP17744631829494884","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg In 100ml Ns","code_information":[{"code":"CP17744631829494506","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg In 50ml","code_information":[{"code":"CP17744631829496433","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg In 50ml Ns","code_information":[{"code":"CP17744631829490203","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg/100ml Ns","code_information":[{"code":"CP17744631829494643","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg/50ml","code_information":[{"code":"CP17744631829492228","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg/50ml Ns","code_information":[{"code":"CP17744631829498518","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg/50ml Ns","code_information":[{"code":"CP17744631829494786","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 400mg/50ml Ns El-d","code_information":[{"code":"CP17744631829495871","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 410mg/50ml","code_information":[{"code":"CP17744631829490562","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":410,"type":"ME"}},{"description":"Daptomycin 413mg In 50ml Ns","code_information":[{"code":"CP17744631829497946","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":413,"type":"ME"}},{"description":"Daptomycin 416mg In 50ml Ns","code_information":[{"code":"CP17744631829492191","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":416,"type":"ME"}},{"description":"Daptomycin 420mg In 50ml Ns","code_information":[{"code":"CP17744631829493391","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Daptomycin 420mg/100ml Ns","code_information":[{"code":"CP17744631829503741","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Daptomycin 425 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829508007","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":425,"type":"ME"}},{"description":"Daptomycin 430mg In 50ml Ns","code_information":[{"code":"CP17744631829508917","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":430,"type":"ME"}},{"description":"Daptomycin 430mg/50ml Ns","code_information":[{"code":"CP17744631829505686","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":430,"type":"ME"}},{"description":"Daptomycin 440mg In 50ml Ns","code_information":[{"code":"CP17744631829504386","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":440,"type":"ME"}},{"description":"Daptomycin 440mg/50ml","code_information":[{"code":"CP17744631829502586","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":440,"type":"ME"}},{"description":"Daptomycin 442mg In 50ml Ns","code_information":[{"code":"CP17744631829500219","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":442,"type":"ME"}},{"description":"Daptomycin 442mg/50ml","code_information":[{"code":"CP17744631829502422","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":442,"type":"ME"}},{"description":"Daptomycin 445 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829505299","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":445,"type":"ME"}},{"description":"Daptomycin 445.8mg/50 Ml Ns","code_information":[{"code":"CP17744631829507618","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":4458,"type":"ME"}},{"description":"Daptomycin 450 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829504286","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829508816","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829509371","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829504925","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829503674","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450mg / 50ml Ns","code_information":[{"code":"CP17744631829507447","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450mg / 50ml Ns","code_information":[{"code":"CP17744631829504559","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450mg In 50ml","code_information":[{"code":"CP17744631829509675","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450mg/50ml","code_information":[{"code":"CP17744631829506537","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 450mg/50ml Ns El-j","code_information":[{"code":"CP17744631829502050","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Daptomycin 460mg/50ml","code_information":[{"code":"CP17744631829509983","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":460,"type":"ME"}},{"description":"Daptomycin 460mg/50ml Ns","code_information":[{"code":"CP17744631829502728","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":460,"type":"ME"}},{"description":"Daptomycin 465.5 Mg In 50ml Ns","code_information":[{"code":"CP17744631829509385","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":4655,"type":"ME"}},{"description":"Daptomycin 466mg / 50ml Ns","code_information":[{"code":"CP17744631829504580","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":466,"type":"ME"}},{"description":"Daptomycin 475 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829503483","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":475,"type":"ME"}},{"description":"Daptomycin 475mg / 50ml Ns","code_information":[{"code":"CP17744631829503967","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":475,"type":"ME"}},{"description":"Daptomycin 475mg / 50ml Ns","code_information":[{"code":"CP17744631829503037","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":475,"type":"ME"}},{"description":"Daptomycin 489.5mg In 50 Ml Ns","code_information":[{"code":"CP17744631829509375","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":4895,"type":"ME"}},{"description":"Daptomycin 490mg / 50ml Ns","code_information":[{"code":"CP17744631829503513","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":490,"type":"ME"}},{"description":"Daptomycin 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829501314","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829501087","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829501571","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829508255","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829501439","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829500171","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829507696","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500/50ml Ns(cubicin","code_information":[{"code":"CP17744631829503289","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Daptomycin 500/50ml Ns(cubicin","code_information":[{"code":"CP17744631829502086","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729043505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Daptomycin 500/50ml Ns(cubicin","code_information":[{"code":"CP17744631829502470","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Daptomycin 500mg / 50ml Ns","code_information":[{"code":"CP17744631829508716","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg In 50ml","code_information":[{"code":"CP17744631829502225","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/100ml Ns","code_information":[{"code":"CP17744631829506868","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729043505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/100ml Ns","code_information":[{"code":"CP17744631829500225","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/100ml Ns","code_information":[{"code":"CP17744631829502835","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/100ml Ns","code_information":[{"code":"CP17744631829503250","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/100ml Ns El","code_information":[{"code":"CP17744631829500993","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/100ml Ns El","code_information":[{"code":"CP17744631829509872","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/100ns Mb","code_information":[{"code":"CP17744631829502447","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/50ml Ns","code_information":[{"code":"CP17744631829503470","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/50ml Ns Mb","code_information":[{"code":"CP17744631829505220","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/50ml Ns Mb","code_information":[{"code":"CP17744631829502538","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/50ml Ns Mb","code_information":[{"code":"CP17744631829500926","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 500mg/50ml Ns Mb","code_information":[{"code":"CP17744631829503941","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomycin 520mg/50ml","code_information":[{"code":"CP17744631829519699","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":520,"type":"ME"}},{"description":"Daptomycin 525 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829510480","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":525,"type":"ME"}},{"description":"Daptomycin 530mg/100ml Ns","code_information":[{"code":"CP17744631829511458","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505622904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":530,"type":"ME"}},{"description":"Daptomycin 540mg/50ml Ns","code_information":[{"code":"CP17744631829519909","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":540,"type":"ME"}},{"description":"Daptomycin 550 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829519432","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829512972","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550mg In 100ml Ns","code_information":[{"code":"CP17744631829519456","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550mg In 100ml Ns","code_information":[{"code":"CP17744631829519494","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550mg In 100ml Ns","code_information":[{"code":"CP17744631829515127","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550mg/100ml Ns","code_information":[{"code":"CP17744631829518464","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550mg/50ml Ns","code_information":[{"code":"CP17744631829516840","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550mg/50ml Ns El-d","code_information":[{"code":"CP17744631829513553","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 560 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829516060","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":560,"type":"ME"}},{"description":"Daptomycin 561.5mg In 50ml Ns","code_information":[{"code":"CP17744631829518246","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":5615,"type":"ME"}},{"description":"Daptomycin 570mg/50ml","code_information":[{"code":"CP17744631829511171","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":570,"type":"ME"}},{"description":"Daptomycin 570mg/50ml Ns","code_information":[{"code":"CP17744631829512452","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":570,"type":"ME"}},{"description":"Daptomycin 575mg/50ml","code_information":[{"code":"CP17744631829519655","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":575,"type":"ME"}},{"description":"Daptomycin 576 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829515030","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":576,"type":"ME"}},{"description":"Daptomycin 576mg In 100ml Ns","code_information":[{"code":"CP17744631829516220","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":576,"type":"ME"}},{"description":"Daptomycin 576mg In 50ml Ns","code_information":[{"code":"CP17744631829515076","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":576,"type":"ME"}},{"description":"Daptomycin 576mg/100ml Ns El-j","code_information":[{"code":"CP17744631829512208","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":576,"type":"ME"}},{"description":"Daptomycin 581mg In 50ml Ns","code_information":[{"code":"CP17744631829511472","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":581,"type":"ME"}},{"description":"Daptomycin 586mg In 100ml Ns","code_information":[{"code":"CP17744631829513984","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":586,"type":"ME"}},{"description":"Daptomycin 588mg In 50ml Ns","code_information":[{"code":"CP17744631829514280","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":588,"type":"ME"}},{"description":"Daptomycin 588mg/50ml Ns","code_information":[{"code":"CP17744631829514392","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":588,"type":"ME"}},{"description":"Daptomycin 590mg/100ml Ns","code_information":[{"code":"CP17744631829513144","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":590,"type":"ME"}},{"description":"Daptomycin 600 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829518781","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829514802","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829519932","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829514977","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829511676","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829517363","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600mg In 50ml","code_information":[{"code":"CP17744631829515997","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600mg/100ml Ns","code_information":[{"code":"CP17744631829518225","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600mg/100ml Ns","code_information":[{"code":"CP17744631829512364","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600mg/100ml Ns","code_information":[{"code":"CP17744631829517930","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600mg/100ml Ns","code_information":[{"code":"CP17744631829513457","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 618 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829518519","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":618,"type":"ME"}},{"description":"Daptomycin 618mg/100ml Nss","code_information":[{"code":"CP17744631829524888","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":618,"type":"ME"}},{"description":"Daptomycin 620mg In 100ml Ns","code_information":[{"code":"CP17744631829520689","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":620,"type":"ME"}},{"description":"Daptomycin 620mg In 100ml Ns","code_information":[{"code":"CP17744631829527195","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":620,"type":"ME"}},{"description":"Daptomycin 620mg/50ml","code_information":[{"code":"CP17744631829525720","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":620,"type":"ME"}},{"description":"Daptomycin 625 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829523607","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Daptomycin 625mg/50ml","code_information":[{"code":"CP17744631829524936","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Daptomycin 630 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829520203","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":630,"type":"ME"}},{"description":"Daptomycin 639.5mg / 100ml Ns","code_information":[{"code":"CP17744631829521651","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":6395,"type":"ME"}},{"description":"Daptomycin 640 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829523510","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":640,"type":"ME"}},{"description":"Daptomycin 640 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829523363","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":640,"type":"ME"}},{"description":"Daptomycin 640mg / 100ml Ns","code_information":[{"code":"CP17744631829522637","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":640,"type":"ME"}},{"description":"Daptomycin 640mg/50ml Ns","code_information":[{"code":"CP17744631829526532","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":640,"type":"ME"}},{"description":"Daptomycin 645mg/100ml Ns","code_information":[{"code":"CP17744631829520624","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":645,"type":"ME"}},{"description":"Daptomycin 648 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829521628","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":648,"type":"ME"}},{"description":"Daptomycin 650 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829523208","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829529817","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829520400","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829522379","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829528294","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829525678","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650mg/100ml Ns","code_information":[{"code":"CP17744631829523418","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650mg/50ml Eld","code_information":[{"code":"CP17744631829523428","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 653 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829526341","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":653,"type":"ME"}},{"description":"Daptomycin 660 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829522754","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":660,"type":"ME"}},{"description":"Daptomycin 675 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829523014","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Daptomycin 675 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829528051","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Daptomycin 675 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829526896","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Daptomycin 675 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829525180","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Daptomycin 675 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829526838","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Daptomycin 675mg/50ml Ns","code_information":[{"code":"CP17744631829521723","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Daptomycin 675mg/50ml Ns","code_information":[{"code":"CP17744631829522781","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Daptomycin 679mg In 100ml Ns","code_information":[{"code":"CP17744631829529844","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":679,"type":"ME"}},{"description":"Daptomycin 690 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829529468","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":690,"type":"ME"}},{"description":"Daptomycin 692 Mg In 100ml Ns","code_information":[{"code":"CP17744631829528693","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":692,"type":"ME"}},{"description":"Daptomycin 700 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829526966","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829527044","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829526864","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829528084","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829523848","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700mg/100ml Ns","code_information":[{"code":"CP17744631829528069","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700mg/100ml Ns","code_information":[{"code":"CP17744631829529433","type":"CDM"},{"code":"250","type":"RC"},{"code":"71839010701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700mg/100ml Ns","code_information":[{"code":"CP17744631829522087","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729043505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 700mg/50 Ml Ns El-d","code_information":[{"code":"CP17744631829522409","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Daptomycin 714 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829524716","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":714,"type":"ME"}},{"description":"Daptomycin 725 Mg/100ml Ns","code_information":[{"code":"CP17744631829521949","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":725,"type":"ME"}},{"description":"Daptomycin 725 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829527791","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":725,"type":"ME"}},{"description":"Daptomycin 725 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829521275","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":725,"type":"ME"}},{"description":"Daptomycin 725.5mg/50 Ml Ns","code_information":[{"code":"CP17744631829534732","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":7255,"type":"ME"}},{"description":"Daptomycin 750 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829538031","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829538776","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829533110","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829532863","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829538283","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829534413","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829534703","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750mg/100ml Ns","code_information":[{"code":"CP17744631829530535","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750mg/50 Ml Ns","code_information":[{"code":"CP17744631829531591","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750mg/50 Ml Ns","code_information":[{"code":"CP17744631829533643","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 750mg/50ml Ns El-d","code_information":[{"code":"CP17744631829532080","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Daptomycin 755mg/50 Ml Ns","code_information":[{"code":"CP17744631829534017","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":755,"type":"ME"}},{"description":"Daptomycin 760mg In 50ml Ns","code_information":[{"code":"CP17744631829538732","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":760,"type":"ME"}},{"description":"Daptomycin 760mg/50ml","code_information":[{"code":"CP17744631829537691","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":760,"type":"ME"}},{"description":"Daptomycin 762.5mg In 100ml Ns","code_information":[{"code":"CP17744631829537752","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":7625,"type":"ME"}},{"description":"Daptomycin 775mg In 100ml Ns","code_information":[{"code":"CP17744631829532519","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":775,"type":"ME"}},{"description":"Daptomycin 775mg/50ml","code_information":[{"code":"CP17744631829536713","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":775,"type":"ME"}},{"description":"Daptomycin 776 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829539943","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":776,"type":"ME"}},{"description":"Daptomycin 800 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829533456","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829533744","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829536731","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829533970","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829534288","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829536557","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg In 100ml Ns","code_information":[{"code":"CP17744631829537934","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg In 50ml","code_information":[{"code":"CP17744631829535191","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg/100 Ml Ns","code_information":[{"code":"CP17744631829537055","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg/100ml Ns","code_information":[{"code":"CP17744631829533238","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg/100ml Ns","code_information":[{"code":"CP17744631829534773","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg/100ml Ns El-j","code_information":[{"code":"CP17744631829538399","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg/50ml","code_information":[{"code":"CP17744631829539368","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 800mg/50ml Eld","code_information":[{"code":"CP17744631829538100","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Daptomycin 825 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829532906","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":825,"type":"ME"}},{"description":"Daptomycin 825mg In 100 Ml Ns","code_information":[{"code":"CP17744631829535290","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":825,"type":"ME"}},{"description":"Daptomycin 825mg/50ml","code_information":[{"code":"CP17744631829536684","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":825,"type":"ME"}},{"description":"Daptomycin 826mg/50ml","code_information":[{"code":"CP17744631829533121","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":826,"type":"ME"}},{"description":"Daptomycin 826mg/50ml Eld","code_information":[{"code":"CP17744631829539357","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":826,"type":"ME"}},{"description":"Daptomycin 828mg In 100ml Ns","code_information":[{"code":"CP17744631829534906","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":828,"type":"ME"}},{"description":"Daptomycin 828mg In 50ml Ns","code_information":[{"code":"CP17744631829534166","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":828,"type":"ME"}},{"description":"Daptomycin 840 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829533601","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":840,"type":"ME"}},{"description":"Daptomycin 840mg/50ml Ns","code_information":[{"code":"CP17744631829531304","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":840,"type":"ME"}},{"description":"Daptomycin 840mg/50ml Ns","code_information":[{"code":"CP17744631829534745","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":840,"type":"ME"}},{"description":"Daptomycin 844mg/100 Ml Ns","code_information":[{"code":"CP17744631829533566","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":844,"type":"ME"}},{"description":"Daptomycin 850 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829535099","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829530474","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829539560","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829530650","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829537463","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850 Mg/50ml Ns","code_information":[{"code":"CP17744631829530777","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850mg In 50ml Ns","code_information":[{"code":"CP17744631829537056","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850mg/100ns(cubic","code_information":[{"code":"CP17744631829533762","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 850mg/50ml Ns","code_information":[{"code":"CP17744631829534883","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Daptomycin 870 Mg/50ml Ns","code_information":[{"code":"CP17744631829538299","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":870,"type":"ME"}},{"description":"Daptomycin 870/50ml","code_information":[{"code":"CP17744631829537076","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Daptomycin 871mg/100ml Ns","code_information":[{"code":"CP17744631829534261","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":871,"type":"ME"}},{"description":"Daptomycin 875 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829539826","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Daptomycin 875/50ml","code_information":[{"code":"CP17744631829532517","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Daptomycin 893 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829541924","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":893,"type":"ME"}},{"description":"Daptomycin 900 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829544980","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900 Mg In 50ml","code_information":[{"code":"CP17744631829544033","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829542374","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829545205","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900mg In 50ml","code_information":[{"code":"CP17744631829542140","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900mg/100ml Ns","code_information":[{"code":"CP17744631829545101","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598041311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900mg/100ml Ns","code_information":[{"code":"CP17744631829544163","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900mg/100ml Ns","code_information":[{"code":"CP17744631829541825","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900mg/100ml Ns El-j","code_information":[{"code":"CP17744631829542960","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 900mg/50ml","code_information":[{"code":"CP17744631829546763","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Daptomycin 912 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829549555","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":912,"type":"ME"}},{"description":"Daptomycin 912mg/100ml Ns El-j","code_information":[{"code":"CP17744631829540409","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":912,"type":"ME"}},{"description":"Daptomycin 925mg In 100ml Ns","code_information":[{"code":"CP17744631829548218","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":925,"type":"ME"}},{"description":"Daptomycin 925mg/100ml Ns","code_information":[{"code":"CP17744631829543315","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":925,"type":"ME"}},{"description":"Daptomycin 950 Mg In 50ml","code_information":[{"code":"CP17744631829542429","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":950,"type":"ME"}},{"description":"Daptomycin 983mg/100ml Ns","code_information":[{"code":"CP17744631829540558","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":983,"type":"ME"}},{"description":"Daptomycin490/ns50","code_information":[{"code":"CP17744631829546333","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831048403","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Lorazep 1mg Diphenh25mg","code_information":[{"code":"CP17744631830368003","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779092700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Qvar Rediha  Aer 80mcg","code_information":[{"code":"CP17744631830874914","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310030480","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Qvar Rediha Aer 80mcg 120inh","code_information":[{"code":"CP17744631830871573","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310030480","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Qvar Redihaler 80mcg/act","code_information":[{"code":"CP17744631830871009","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310030480","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Deferasirox  Gra 360mg","code_information":[{"code":"CP17744631829543028","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097057053","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Nitroglycern Sub 0.3mg","code_information":[{"code":"CP17744631830564262","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762492101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Envarsus Xr  Tab 4mg","code_information":[{"code":"CP17744631829790510","type":"CDM"},{"code":"250","type":"RC"},{"code":"68992304003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Envarsus Xr  Tab 4mg","code_information":[{"code":"CP17744631829795274","type":"CDM"},{"code":"250","type":"RC"},{"code":"68992304001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830069956","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Wheelchair   Mis Cushion","code_information":[{"code":"CP17744631831375661","type":"CDM"},{"code":"250","type":"RC"},{"code":"8225281600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 60mg Er","code_information":[{"code":"CP17744631830724202","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011046020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":23,"maximum":29,"gross_charge":29,"discounted_cash":29,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":29},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Coban Wrap   Mis 4\"x5yds","code_information":[{"code":"CP17744631829399273","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333158401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Pad 4\"x5\"","code_information":[{"code":"CP17744631830402829","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003140","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Pad 4\"x5\"","code_information":[{"code":"CP17744631830406873","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003141","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tresiba Flex 100 Units/ml 3ml","code_information":[{"code":"CP17744631831171098","type":"CDM"},{"code":"250","type":"RC"},{"code":"16926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Tresiba Flex Inj 100unit","code_information":[{"code":"CP17744631831171828","type":"CDM"},{"code":"250","type":"RC"},{"code":"16926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Fosfomycin   Pow 3gm","code_information":[{"code":"CP17744631829996181","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097057967","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Olanzapine   Inj 10mg","code_information":[{"code":"CP17744631830666789","type":"CDM"},{"code":"250","type":"RC"},{"code":"51709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Epinephrine  Inj 0.15mg","code_information":[{"code":"CP17744631829790546","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Baclofen     Tab 15mg","code_information":[{"code":"CP17744631828821131","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817031810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Kynmobi      Mis 15mg","code_information":[{"code":"CP17744631830192274","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402001530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Kynmobi      Mis 20mg","code_information":[{"code":"CP17744631830195403","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402002030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830824813","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722061090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Acetazolamide 500 Mg/100ml Ns","code_information":[{"code":"CP17744631828268439","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Difluprednat Emu 0.05%","code_information":[{"code":"CP17744631829601109","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238138003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830069318","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Novolog      Inj Flexpen","code_information":[{"code":"CP17744631830576522","type":"CDM"},{"code":"250","type":"RC"},{"code":"16963","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Novolog 100 Unit/ml Flxpen 3ml","code_information":[{"code":"CP17744631830572583","type":"CDM"},{"code":"250","type":"RC"},{"code":"16963","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolog 70/30 Flexpen","code_information":[{"code":"CP17744631830574005","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolog Mix  Inj Flexpen","code_information":[{"code":"CP17744631830574582","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Novolog Mix 70/30 Flexpen","code_information":[{"code":"CP17744631830575360","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolog Mix 70/30 Flexpen 3ml","code_information":[{"code":"CP17744631830572917","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Aquacel Ag   Pad 3.5\"x4\"","code_information":[{"code":"CP17744631828730921","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455011116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Port Access Kit","code_information":[{"code":"CP17744631830788511","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999990030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humulin      Inj 70/30kwp","code_information":[{"code":"CP17744631830099655","type":"CDM"},{"code":"250","type":"RC"},{"code":"28803","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Humulin 70/30 Pen 3 Ml","code_information":[{"code":"CP17744631830096740","type":"CDM"},{"code":"250","type":"RC"},{"code":"28803","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Humulin N    Inj U-100kwp","code_information":[{"code":"CP17744631830095006","type":"CDM"},{"code":"250","type":"RC"},{"code":"28805","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humulin N 100 Units/ml Pen 3ml","code_information":[{"code":"CP17744631830099997","type":"CDM"},{"code":"250","type":"RC"},{"code":"28805","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Nuedexta     Cap 20-10mg","code_information":[{"code":"CP17744631830648307","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148005316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nuedexta 20/10 Mg","code_information":[{"code":"CP17744631830647025","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148005316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lidoderm     Dis 5%","code_information":[{"code":"CP17744631830349154","type":"CDM"},{"code":"250","type":"RC"},{"code":"61959000130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 60mg Cr","code_information":[{"code":"CP17744631830727688","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011046010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Oxycontin    Tab 60mg Er","code_information":[{"code":"CP17744631830720099","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011046010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Oxycontin Er 60mg Tabs","code_information":[{"code":"CP17744631830725966","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011046010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Phytonadione Liq","code_information":[{"code":"CP17744631830762132","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779182204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iopidine     Sol 1% Op","code_information":[{"code":"CP17744631830157226","type":"CDM"},{"code":"250","type":"RC"},{"code":"82667020001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betimol      Sol 0.25%","code_information":[{"code":"CP17744631828874834","type":"CDM"},{"code":"250","type":"RC"},{"code":"76478000105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Timolol Gel  Sol 0.5% Op","code_information":[{"code":"CP17744631831139822","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829236860","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Metformin    Tab 625mg","code_information":[{"code":"CP17744631830437007","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135068130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Naloxone Hcl Spr 4mg","code_information":[{"code":"CP17744631830532806","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802081184","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Walker Boot Non-pneumatic","code_information":[{"code":"CP17744631831308773","type":"CDM"},{"code":"250","type":"RC"},{"code":"15579955070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":28,"gross_charge":28,"discounted_cash":28,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":28},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fiasp        Inj 100/ml","code_information":[{"code":"CP17744631829947960","type":"CDM"},{"code":"250","type":"RC"},{"code":"16932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Fiasp 100 Units/ml Mdv 10ml","code_information":[{"code":"CP17744631829946481","type":"CDM"},{"code":"250","type":"RC"},{"code":"16932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Bp Monitor   Mis","code_information":[{"code":"CP17744631828942256","type":"CDM"},{"code":"250","type":"RC"},{"code":"93764060157","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sunosi       Tab 150mg","code_information":[{"code":"CP17744631831081217","type":"CDM"},{"code":"250","type":"RC"},{"code":"68727035101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831231294","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781059891","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Deferasirox  Tab 360mg","code_information":[{"code":"CP17744631829540009","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722001330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830405641","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121146702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Hysingla Er  Tab 40 Mg","code_information":[{"code":"CP17744631830125384","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011027360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Acyclovir    Cre 5%","code_information":[{"code":"CP17744631828337157","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672136105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Nitroglycern Sub 0.4mg","code_information":[{"code":"CP17744631830579100","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762330401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Brimonidine  Sol 0.1%","code_information":[{"code":"CP17744631828945311","type":"CDM"},{"code":"250","type":"RC"},{"code":"82182032105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxacillin 2g/100ml Ns","code_information":[{"code":"CP17744631830707030","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021016224","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Imvexxy Main Sup 10mcg","code_information":[{"code":"CP17744631830133613","type":"CDM"},{"code":"250","type":"RC"},{"code":"50261011008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Imvexxy Main Sup 4mcg","code_information":[{"code":"CP17744631830137121","type":"CDM"},{"code":"250","type":"RC"},{"code":"50261010408","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Diclofenac   Gel 1%","code_information":[{"code":"CP17744631829599526","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097052444","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Semglee      Inj 100u/ml","code_information":[{"code":"CP17744631831000764","type":"CDM"},{"code":"250","type":"RC"},{"code":"83257001111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Semglee      Inj 100u/ml","code_information":[{"code":"CP17744631831000080","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502025175","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Semglee      Sol 100u/ml","code_information":[{"code":"CP17744631831006667","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502025080","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Semglee 100 Units/ml Mdv 10ml","code_information":[{"code":"CP17744631831003948","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502025080","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Semglee 100 Units/ml Pen 3ml","code_information":[{"code":"CP17744631831000435","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502025175","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Micafungin   Inj 100mg","code_information":[{"code":"CP17744631830479040","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023023010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Micafungin 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830473822","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023023010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Micafungin 100mg/100ml Kit","code_information":[{"code":"CP17744631830470896","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023023010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Micafungin 150 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830470304","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023023010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Micafungin 150mg/100 Ml Ns","code_information":[{"code":"CP17744631830474185","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023023010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Coreg Cr     Cap 40mg","code_information":[{"code":"CP17744631829424197","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784038713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sensipar 30mg Tabs","code_information":[{"code":"CP17744631831002516","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513007330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ciclopirox   Sol 8%","code_information":[{"code":"CP17744631829225394","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192071506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Trizivir     Tab","code_information":[{"code":"CP17744631831193580","type":"CDM"},{"code":"250","type":"RC"},{"code":"49702021718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Promethegan  Sup 50mg","code_information":[{"code":"CP17744631830843919","type":"CDM"},{"code":"250","type":"RC"},{"code":"71301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Algisite M   Mis 4\"x4\"","code_information":[{"code":"CP17744631828406763","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565011829","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Advair Hfa   Aer 115/21","code_information":[{"code":"CP17744631828357213","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":115,"type":"EA"}},{"description":"Advair Hfa Aer 115/21 120inh","code_information":[{"code":"CP17744631828353617","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":115,"type":"EA"}},{"description":"Oxymorphone  Tab 40mg Er","code_information":[{"code":"CP17744631830729408","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896070113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Symbicort    Aer 160-4.5","code_information":[{"code":"CP17744631831082675","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Symbicort  Aer 160-4.5 60inh","code_information":[{"code":"CP17744631831088837","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Lidoderm     Dis 5%","code_information":[{"code":"CP17744631830342983","type":"CDM"},{"code":"250","type":"RC"},{"code":"63481068706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":22,"maximum":27,"gross_charge":27,"discounted_cash":27,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":27},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ins Asp Prot Inj Flexpen","code_information":[{"code":"CP17744631830142154","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ins Aspart 70/30 Protamine Pen","code_information":[{"code":"CP17744631830145253","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Insulin Aspart 70/30 Fxpen 3ml","code_information":[{"code":"CP17744631830148070","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Insulin Aspart Mix 70/30 Pen","code_information":[{"code":"CP17744631830140500","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Insulin Aspart Prot 70/30","code_information":[{"code":"CP17744631830145005","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Inj 6mg/0.5","code_information":[{"code":"CP17744631831077322","type":"CDM"},{"code":"250","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830403950","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121146705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Vtama        Cre 1%","code_information":[{"code":"CP17744631831307753","type":"CDM"},{"code":"250","type":"RC"},{"code":"81672505101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Banzel       Tab 400mg","code_information":[{"code":"CP17744631828833139","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856058352","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830405242","type":"CDM"},{"code":"250","type":"RC"},{"code":"54854","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pen G Proc   Inj 600000","code_information":[{"code":"CP17744631830742593","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793013110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":600000,"type":"EA"}},{"description":"Dulera       Aer 100-5mcg","code_information":[{"code":"CP17744631829754576","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dulera       Aer 100-5mcg","code_information":[{"code":"CP17744631829759136","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dulera       Aer 200-5mcg","code_information":[{"code":"CP17744631829752070","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dulera       Aer 200-5mcg","code_information":[{"code":"CP17744631829754483","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dulera   Aer 200-5mcg 120 Inh","code_information":[{"code":"CP17744631829755618","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dulera   Aer 200-5mcg 60 Inh","code_information":[{"code":"CP17744631829754295","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dulera  Aer 100-5mcg 120 Inh","code_information":[{"code":"CP17744631829754597","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dulera  Aer 100-5mcg 60 Inh","code_information":[{"code":"CP17744631829751112","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Insulin Glar Inj 300/ml","code_information":[{"code":"CP17744631830146640","type":"CDM"},{"code":"250","type":"RC"},{"code":"95529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Insulin Glarg Max 300unit/ml","code_information":[{"code":"CP17744631830144829","type":"CDM"},{"code":"250","type":"RC"},{"code":"95529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":300,"type":"UN"}},{"description":"Insulin Glar Inj 300/ml","code_information":[{"code":"CP17744631830147736","type":"CDM"},{"code":"250","type":"RC"},{"code":"95539","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Travoprost   Dro 0.004%","code_information":[{"code":"CP17744631831160339","type":"CDM"},{"code":"250","type":"RC"},{"code":"78161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nuedexta     Cap 20-10mg","code_information":[{"code":"CP17744631830646369","type":"CDM"},{"code":"250","type":"RC"},{"code":"64597030160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nuedexta 20-10mg Caps","code_information":[{"code":"CP17744631830642115","type":"CDM"},{"code":"250","type":"RC"},{"code":"64597030160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rasagiline   Tab 0.5mg","code_information":[{"code":"CP17744631830871612","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571022030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Acetylcyst   Sol 20%","code_information":[{"code":"CP17744631828267099","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Acetylcysteine 10% Ophth Drop","code_information":[{"code":"CP17744631828300912","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 10% Ophth Sol","code_information":[{"code":"CP17744631828303042","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 20% Soln Vial","code_information":[{"code":"CP17744631828313006","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Ampicillin 12gm/1000ml Ns","code_information":[{"code":"CP17744631828528186","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860011899","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Chlorpromaz  Inj 25mg/ml","code_information":[{"code":"CP17744631829213228","type":"CDM"},{"code":"250","type":"RC"},{"code":"64113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Genetal Tear Mod/acetylcyst","code_information":[{"code":"CP17744631830029266","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naloxone Hcl Spr","code_information":[{"code":"CP17744631830534369","type":"CDM"},{"code":"250","type":"RC"},{"code":"93216","type":"CPT","modifier":"568"}],"standard_charges":[{"setting":"outpatient","modifier_code":["568"],"minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naloxone Hcl Spr 4mg","code_information":[{"code":"CP17744631830530285","type":"CDM"},{"code":"250","type":"RC"},{"code":"93216","type":"CPT","modifier":"568"}],"standard_charges":[{"setting":"outpatient","modifier_code":["568"],"minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Phytonadione Inj 10mg/ml","code_information":[{"code":"CP17744631830766132","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sevelam Carb Pow 0.8gm","code_information":[{"code":"CP17744631831004435","type":"CDM"},{"code":"250","type":"RC"},{"code":"11513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Sevelamer    Pow 0.8gm","code_information":[{"code":"CP17744631831000353","type":"CDM"},{"code":"250","type":"RC"},{"code":"11513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Sevelamer Carb Pack 0.8gm","code_information":[{"code":"CP17744631831010346","type":"CDM"},{"code":"250","type":"RC"},{"code":"11513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Sevelamer Carbonate Pack 0.8gm","code_information":[{"code":"CP17744631831012578","type":"CDM"},{"code":"250","type":"RC"},{"code":"11513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Nucynta Er   Tab 100mg","code_information":[{"code":"CP17744631830641834","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510011660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Simbrinza    Sus 1-0.2%","code_information":[{"code":"CP17744631831027139","type":"CDM"},{"code":"250","type":"RC"},{"code":"78090","type":"CPT","modifier":"438"}],"standard_charges":[{"setting":"outpatient","modifier_code":["438"],"minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ongentys     Cap 25mg","code_information":[{"code":"CP17744631830690385","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896040201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ongentys     Cap 50mg","code_information":[{"code":"CP17744631830694462","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896040301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Aciphex      Tab 20mg","code_information":[{"code":"CP17744631828328117","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784024330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Coreg        Tab 25mg","code_information":[{"code":"CP17744631829421479","type":"CDM"},{"code":"250","type":"RC"},{"code":"80725014220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tigecycline 100mg/100ml","code_information":[{"code":"CP17744631831125059","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tigecycline 200mg/250ml El-m","code_information":[{"code":"CP17744631831122027","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Humalog Mix  Inj 50/50","code_information":[{"code":"CP17744631830081652","type":"CDM"},{"code":"250","type":"RC"},{"code":"27512","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Clobazam     Tab 10mg","code_information":[{"code":"CP17744631829260995","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571031501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bromfenac    Sol 0.09% Op","code_information":[{"code":"CP17744631828950499","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266014201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Risedronate  Tab 30mg","code_information":[{"code":"CP17744631830896117","type":"CDM"},{"code":"250","type":"RC"},{"code":"93310","type":"CPT","modifier":"56"}],"standard_charges":[{"setting":"outpatient","modifier_code":["56"],"minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Bimatoprost  Sol 0.03%","code_information":[{"code":"CP17744631828885344","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180042901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830063113","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069038305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Standard Hip/knee Kit","code_information":[{"code":"CP17744631831064809","type":"CDM"},{"code":"250","type":"RC"},{"code":"54756540241","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Inj 6/0.5ml","code_information":[{"code":"CP17744631831072687","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679072801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":21,"maximum":26,"gross_charge":26,"discounted_cash":26,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":26},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Zenpep       Cap 60000unt","code_information":[{"code":"CP17744631831391895","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":60000,"type":"EA"}},{"description":"Estrad Val   Inj 10mg/ml","code_information":[{"code":"CP17744631829813435","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700027322","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pulse Finger Mis Oximeter","code_information":[{"code":"CP17744631830858333","type":"CDM"},{"code":"250","type":"RC"},{"code":"52308011566","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prozac       Cap 40mg","code_information":[{"code":"CP17744631830855492","type":"CDM"},{"code":"250","type":"RC"},{"code":"77731","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Acetylcyst   Sol 20%","code_information":[{"code":"CP17744631828261496","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Acetylcysteine 10% Ophth Sol","code_information":[{"code":"CP17744631828303444","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 20% Soln Vial","code_information":[{"code":"CP17744631828317591","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Acetylcysteine 20% Solution","code_information":[{"code":"CP17744631828310287","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831117796","type":"CDM"},{"code":"250","type":"RC"},{"code":"51718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Hose T.e.d. Lg-rg Kne Cur","code_information":[{"code":"CP17744631830081989","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290204289","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Solu-cortef  Inj 100mg","code_information":[{"code":"CP17744631831056474","type":"CDM"},{"code":"250","type":"RC"},{"code":"90011","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"New Day      Tab 1.5mg","code_information":[{"code":"CP17744631830555339","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714080901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Moxifloxacin Sol Hcl 0.5%","code_information":[{"code":"CP17744631830518912","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Trexall      Tab 5mg","code_information":[{"code":"CP17744631831174676","type":"CDM"},{"code":"250","type":"RC"},{"code":"51285036601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Briviact     Tab 100mg","code_information":[{"code":"CP17744631828954601","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474077066","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Briviact     Tab 100mg","code_information":[{"code":"CP17744631828954168","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474077009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Briviact     Tab 10mg","code_information":[{"code":"CP17744631828956254","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474037066","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Briviact     Tab 25mg","code_information":[{"code":"CP17744631828953562","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474047066","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Briviact     Tab 75mg","code_information":[{"code":"CP17744631828959796","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474067066","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Farxiga      Tab 5mg","code_information":[{"code":"CP17744631829844963","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Onetouch     Kit Ultra 2","code_information":[{"code":"CP17744631830684689","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885004601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefepime     Inj 2g/100ml","code_information":[{"code":"CP17744631829164679","type":"CDM"},{"code":"250","type":"RC"},{"code":"33813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/100ml Dex","code_information":[{"code":"CP17744631829162582","type":"CDM"},{"code":"250","type":"RC"},{"code":"33813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829227215","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806026797","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Flarex       Sus 0.1% Op","code_information":[{"code":"CP17744631829955548","type":"CDM"},{"code":"250","type":"RC"},{"code":"71776010005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Infrared Thermometer","code_information":[{"code":"CP17744631830141978","type":"CDM"},{"code":"250","type":"RC"},{"code":"69724809100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naloxone     Spr","code_information":[{"code":"CP17744631830539726","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naloxone     Spr 4mg","code_information":[{"code":"CP17744631830536266","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Naloxone 4mg Nasal Spray 2 Ct","code_information":[{"code":"CP17744631830530611","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nicotine Td  Dis 14mg/24h","code_information":[{"code":"CP17744631830551617","type":"CDM"},{"code":"250","type":"RC"},{"code":"53658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Olanzapine   Inj 10mg","code_information":[{"code":"CP17744631830663953","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603018101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Seat Cushion Foam / Gel","code_information":[{"code":"CP17744631830990168","type":"CDM"},{"code":"250","type":"RC"},{"code":"17074014000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Test Strips Gluco Perfct","code_information":[{"code":"CP17744631831114390","type":"CDM"},{"code":"250","type":"RC"},{"code":"6496434253","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin 250mg/5ml","code_information":[{"code":"CP17744631831249735","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Bath Bench   Mis /Back","code_information":[{"code":"CP17744631828837928","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917015887","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Intelence    Tab 200mg","code_information":[{"code":"CP17744631830159151","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676057101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Optichamber  Mis Dia Lg","code_information":[{"code":"CP17744631830694654","type":"CDM"},{"code":"250","type":"RC"},{"code":"8373982700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rytary       Cap 95mg","code_information":[{"code":"CP17744631830926472","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Rytary Er 23.75mg/95mg Caps","code_information":[{"code":"CP17744631830923585","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":2375,"type":"ME"}},{"description":"Ampicillin/sulb 9gm/250 Ml Ns","code_information":[{"code":"CP17744631828528062","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567021201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":9,"type":"GR"}},{"description":"Commode Non-fldng Stl","code_information":[{"code":"CP17744631829417597","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Buprenorphin Dis 15mcg/hr","code_information":[{"code":"CP17744631828975736","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781041904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lovenox      Inj 40/0.4ml","code_information":[{"code":"CP17744631830372195","type":"CDM"},{"code":"250","type":"RC"},{"code":"75062","type":"CPT","modifier":"40"}],"standard_charges":[{"setting":"outpatient","modifier_code":["40"],"minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Lovenox   Suv 40mg/0.4ml Dose","code_information":[{"code":"CP17744631830372299","type":"CDM"},{"code":"250","type":"RC"},{"code":"75062","type":"CPT","modifier":"40"}],"standard_charges":[{"setting":"outpatient","modifier_code":["40"],"minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Solu-cortef  Inj 100mg","code_information":[{"code":"CP17744631831057123","type":"CDM"},{"code":"250","type":"RC"},{"code":"90011","type":"CPT","modifier":"4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["4"],"minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sps          Sus 15gm/60","code_information":[{"code":"CP17744631831062977","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Sps 15gm/60ml Susp","code_information":[{"code":"CP17744631831062858","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Lyumjev      Inj 100ut/ml","code_information":[{"code":"CP17744631830396808","type":"CDM"},{"code":"250","type":"RC"},{"code":"27728","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Lyumjev Muv 100/ml 10ml","code_information":[{"code":"CP17744631830394152","type":"CDM"},{"code":"250","type":"RC"},{"code":"27728","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Ibandronate  Tab 150mg","code_information":[{"code":"CP17744631830128980","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862023703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828945996","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505058901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828949431","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505622500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Aztreonam    Inj 1gm","code_information":[{"code":"CP17744631828812167","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Aztreonam 1 Gm/50 Ml Ns","code_information":[{"code":"CP17744631828813327","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Aztreonam 1gm/100ml Ns","code_information":[{"code":"CP17744631828819996","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Aztreonam 1gm/50ml D5w","code_information":[{"code":"CP17744631828817579","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Aztreonam 1gm/50ml D5w Vm","code_information":[{"code":"CP17744631828814300","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Aztreonam 1gm/50ml Mb Ns","code_information":[{"code":"CP17744631828813340","type":"CDM"},{"code":"250","type":"RC"},{"code":"40908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Blood Press  Mis Wrist","code_information":[{"code":"CP17744631828934258","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295012930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Octreotide   Inj 1000mcg","code_information":[{"code":"CP17744631830652999","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20,"maximum":25,"gross_charge":25,"discounted_cash":25,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":25},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830662762","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208041010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Tab 25mg","code_information":[{"code":"CP17744631831084765","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111029136","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Oxtellar Xr  Tab 600mg","code_information":[{"code":"CP17744631830705967","type":"CDM"},{"code":"250","type":"RC"},{"code":"17772012301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxtellar Xr 600mg Tabs","code_information":[{"code":"CP17744631830709240","type":"CDM"},{"code":"250","type":"RC"},{"code":"17772012301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Dextrose     Inj 50%","code_information":[{"code":"CP17744631829589375","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329330201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Breyna       Aer 160/4.5","code_information":[{"code":"CP17744631828940316","type":"CDM"},{"code":"250","type":"RC"},{"code":"37875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Breyna   Aer 160/4.5 120inh","code_information":[{"code":"CP17744631828946185","type":"CDM"},{"code":"250","type":"RC"},{"code":"37875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Entresto     Tab 24-26mg","code_information":[{"code":"CP17744631829795161","type":"CDM"},{"code":"250","type":"RC"},{"code":"78065","type":"CPT","modifier":"967"}],"standard_charges":[{"setting":"outpatient","modifier_code":["967"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Entresto     Tab 49-51mg","code_information":[{"code":"CP17744631829795672","type":"CDM"},{"code":"250","type":"RC"},{"code":"78077","type":"CPT","modifier":"720"}],"standard_charges":[{"setting":"outpatient","modifier_code":["720"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":49,"type":"ME"}},{"description":"Entresto 24-26mg Tabs","code_information":[{"code":"CP17744631829799484","type":"CDM"},{"code":"250","type":"RC"},{"code":"78065","type":"CPT","modifier":"967"}],"standard_charges":[{"setting":"outpatient","modifier_code":["967"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Entresto 49mg-51mg Tab","code_information":[{"code":"CP17744631829797104","type":"CDM"},{"code":"250","type":"RC"},{"code":"78077","type":"CPT","modifier":"720"}],"standard_charges":[{"setting":"outpatient","modifier_code":["720"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":49,"type":"ME"}},{"description":"Acticoat 7   Pad 4\"x5\"","code_information":[{"code":"CP17744631828328897","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565012137","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Knee Brace Hinged Adjustable","code_information":[{"code":"CP17744631830190567","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020159","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Optichamber  Mis Dia Sm","code_information":[{"code":"CP17744631830691513","type":"CDM"},{"code":"250","type":"RC"},{"code":"8373982300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromfenac    Dro 0.07% Op","code_information":[{"code":"CP17744631828950731","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505100602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Contour      Kit Next","code_information":[{"code":"CP17744631829414751","type":"CDM"},{"code":"250","type":"RC"},{"code":"19373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fondaparinux Inj 10/0.8ml","code_information":[{"code":"CP17744631829994548","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111068110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Ampicillin12gm/500ml","code_information":[{"code":"CP17744631828528212","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Calcitriol   Sol 1mcg/ml","code_information":[{"code":"CP17744631829068074","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980044715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Daptomycin   Inj 350mg","code_information":[{"code":"CP17744631829488068","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 100mg/50ml Ns","code_information":[{"code":"CP17744631829481849","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Daptomycin 1050mg/100ml Ns Kit","code_information":[{"code":"CP17744631829481923","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1050,"type":"ME"}},{"description":"Daptomycin 250 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829483725","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Daptomycin 270/50ml Ns","code_information":[{"code":"CP17744631829486858","type":"CDM"},{"code":"250","type":"RC"},{"code":"71839010801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Daptomycin 300 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631829494173","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 300mg/50ml Ns","code_information":[{"code":"CP17744631829490028","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Daptomycin 330 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829490150","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Daptomycin 350 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829499093","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 3500mg/50ml Ns Mb","code_information":[{"code":"CP17744631829493496","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":3500,"type":"ME"}},{"description":"Daptomycin 350mg In 50ml Ns","code_information":[{"code":"CP17744631829496070","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Daptomycin 520mg/100ml Ns","code_information":[{"code":"CP17744631829504775","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":520,"type":"ME"}},{"description":"Daptomycin 545mg In 100ml Ns","code_information":[{"code":"CP17744631829510234","type":"CDM"},{"code":"250","type":"RC"},{"code":"71839010801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":545,"type":"ME"}},{"description":"Daptomycin 550mg In 100ml Ns","code_information":[{"code":"CP17744631829510967","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 550mg/50ml Ns","code_information":[{"code":"CP17744631829517792","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Daptomycin 560 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829519877","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":560,"type":"ME"}},{"description":"Daptomycin 560/ Ns 0.9% 100ml","code_information":[{"code":"CP17744631829518290","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Daptomycin 575mg/50ml Ns","code_information":[{"code":"CP17744631829519642","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":575,"type":"ME"}},{"description":"Daptomycin 595mg In 100ml Ns","code_information":[{"code":"CP17744631829510666","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":595,"type":"ME"}},{"description":"Daptomycin 600 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829512763","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829512358","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 600mg/100ml Ns El-j","code_information":[{"code":"CP17744631829519593","type":"CDM"},{"code":"250","type":"RC"},{"code":"71839010801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 615mg/50ml Ns","code_information":[{"code":"CP17744631829519020","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":615,"type":"ME"}},{"description":"Daptomycin 625mg/50ml Ns","code_information":[{"code":"CP17744631829524503","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Daptomycin 630mg/100ml Ns","code_information":[{"code":"CP17744631829520439","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":630,"type":"ME"}},{"description":"Daptomycin 648 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829525846","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":648,"type":"ME"}},{"description":"Daptomycin 648 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829525117","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":648,"type":"ME"}},{"description":"Daptomycin 650 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631829521991","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829525868","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 650mg/100ml Ns El-j","code_information":[{"code":"CP17744631829521980","type":"CDM"},{"code":"250","type":"RC"},{"code":"71839010801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Daptomycin 652mg 100ml Ns","code_information":[{"code":"CP17744631829523191","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":652,"type":"ME"}},{"description":"Daptomycin 700 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829527229","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288001715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Naloxone Hcl Spr 4mg","code_information":[{"code":"CP17744631830533350","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802057884","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Cast Boot Large","code_information":[{"code":"CP17744631829145774","type":"CDM"},{"code":"250","type":"RC"},{"code":"70878000186","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dulera       Aer 100-5mcg","code_information":[{"code":"CP17744631829751508","type":"CDM"},{"code":"250","type":"RC"},{"code":"85720","type":"CPT","modifier":"607"}],"standard_charges":[{"setting":"outpatient","modifier_code":["607"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dulera       Aer 100-5mcg","code_information":[{"code":"CP17744631829755636","type":"CDM"},{"code":"250","type":"RC"},{"code":"85720","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dulera       Aer 200-5mcg","code_information":[{"code":"CP17744631829758214","type":"CDM"},{"code":"250","type":"RC"},{"code":"85461","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dulera       Aer 200-5mcg","code_information":[{"code":"CP17744631829759202","type":"CDM"},{"code":"250","type":"RC"},{"code":"85461","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dulera       Aer 50-5mcg","code_information":[{"code":"CP17744631829756690","type":"CDM"},{"code":"250","type":"RC"},{"code":"85222","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dulera 200mcg/5mcg Inhaler","code_information":[{"code":"CP17744631829751081","type":"CDM"},{"code":"250","type":"RC"},{"code":"85461","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dulera 200mcg/5mcg Inhaler","code_information":[{"code":"CP17744631829755929","type":"CDM"},{"code":"250","type":"RC"},{"code":"85461","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Toilet Seat Raised (No Arms)","code_information":[{"code":"CP17744631831147268","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601013100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kerendia     Tab 10mg","code_information":[{"code":"CP17744631830189207","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419054002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Kerendia     Tab 10mg","code_information":[{"code":"CP17744631830184453","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419054001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Kerendia     Tab 20mg","code_information":[{"code":"CP17744631830180221","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419054101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Kerendia     Tab 20mg","code_information":[{"code":"CP17744631830185016","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419054102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Qbrexza      Pad 2.4%","code_information":[{"code":"CP17744631830859099","type":"CDM"},{"code":"250","type":"RC"},{"code":"69489041130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Shower Chair Bariatric","code_information":[{"code":"CP17744631831012172","type":"CDM"},{"code":"250","type":"RC"},{"code":"81506707193","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Shower Chair W Back","code_information":[{"code":"CP17744631831013451","type":"CDM"},{"code":"250","type":"RC"},{"code":"16958051002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Milk Of Magn Sus 2400/10","code_information":[{"code":"CP17744631830487601","type":"CDM"},{"code":"250","type":"RC"},{"code":"12109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":2400,"type":"EA"}},{"description":"Flucytosine  Cap 500mg","code_information":[{"code":"CP17744631829961138","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651033201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Gynazole-1   Cre 2%","code_information":[{"code":"CP17744631830069915","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802039601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Steglatro    Tab 15mg","code_information":[{"code":"CP17744631831062034","type":"CDM"},{"code":"250","type":"RC"},{"code":"65364","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Depo-testost Inj 200mg/ml","code_information":[{"code":"CP17744631829555693","type":"CDM"},{"code":"250","type":"RC"},{"code":"90417","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Risedron Sod Tab 35mg Dr","code_information":[{"code":"CP17744631830892742","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762040704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Zyprexa      Tab 10mg","code_information":[{"code":"CP17744631831417028","type":"CDM"},{"code":"250","type":"RC"},{"code":"24117","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Insulin Lisp Inj 100/ml","code_information":[{"code":"CP17744631830142294","type":"CDM"},{"code":"250","type":"RC"},{"code":"27737","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insulin Lispro 100 Unit/ml Mdv","code_information":[{"code":"CP17744631830149299","type":"CDM"},{"code":"250","type":"RC"},{"code":"27737","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Lispro 100 Unit/ml Vl","code_information":[{"code":"CP17744631830143341","type":"CDM"},{"code":"250","type":"RC"},{"code":"27737","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Lispro 100unit/ml Soln","code_information":[{"code":"CP17744631830144714","type":"CDM"},{"code":"250","type":"RC"},{"code":"27737","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Lispro 100unit/ml Vial","code_information":[{"code":"CP17744631830142261","type":"CDM"},{"code":"250","type":"RC"},{"code":"27737","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Tigecycline  Inj 50mg","code_information":[{"code":"CP17744631831120767","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline 100mg In 100ml Ns","code_information":[{"code":"CP17744631831129403","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tigecycline 25mg/100ml Ns","code_information":[{"code":"CP17744631831122746","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tigecycline 50 Mg/100 Ml Ns","code_information":[{"code":"CP17744631831138120","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline 50mg / 100ml Ns","code_information":[{"code":"CP17744631831134614","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline 50mg Solr","code_information":[{"code":"CP17744631831135845","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline 50mg/100ml Mb+","code_information":[{"code":"CP17744631831138447","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tigecycline 50mg/100ml Ns 0.9%","code_information":[{"code":"CP17744631831134095","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150022810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Verquvo      Tab 10mg","code_information":[{"code":"CP17744631831269635","type":"CDM"},{"code":"250","type":"RC"},{"code":"65030","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Verquvo      Tab 2.5mg","code_information":[{"code":"CP17744631831267010","type":"CDM"},{"code":"250","type":"RC"},{"code":"65028","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Verquvo      Tab 5mg","code_information":[{"code":"CP17744631831269997","type":"CDM"},{"code":"250","type":"RC"},{"code":"65029","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Verquvo      Tab 5mg","code_information":[{"code":"CP17744631831268893","type":"CDM"},{"code":"250","type":"RC"},{"code":"65029","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tetrabenazin Tab 25mg","code_information":[{"code":"CP17744631831114387","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722082211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tetrabenazin Tab 25mg","code_information":[{"code":"CP17744631831115199","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436010209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830666532","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238161503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ofloxacin Otic 0.3% Drops","code_information":[{"code":"CP17744631830661353","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238161503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Gel Cushion Seat","code_information":[{"code":"CP17744631830029004","type":"CDM"},{"code":"250","type":"RC"},{"code":"75475634002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omnaris      Spr","code_information":[{"code":"CP17744631830682723","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515070101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":19,"maximum":24,"gross_charge":24,"discounted_cash":24,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":24},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Voquezna     Tab 10mg","code_information":[{"code":"CP17744631831306732","type":"CDM"},{"code":"250","type":"RC"},{"code":"81520010030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Voquezna     Tab 20mg","code_information":[{"code":"CP17744631831302688","type":"CDM"},{"code":"250","type":"RC"},{"code":"81520020030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Synjardy     Tab","code_information":[{"code":"CP17744631831088306","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Synjardy 12.5/1000mg Tab","code_information":[{"code":"CP17744631831083397","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Synjardy 12.5/1000mg Tabs","code_information":[{"code":"CP17744631831084138","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Synjardy 12.5-1,000 Mg Tablet","code_information":[{"code":"CP17744631831082790","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Synjardy--tabs 12.51000mg","code_information":[{"code":"CP17744631831086133","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Raised Toilet Seat","code_information":[{"code":"CP17744631830877979","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999990244","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Male Sol 0.5%","code_information":[{"code":"CP17744631831132802","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505100504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cefoxitin 2gm/100ml Ns","code_information":[{"code":"CP17744631829174728","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cyclogyl     Sol 2% Op","code_information":[{"code":"CP17744631829449805","type":"CDM"},{"code":"250","type":"RC"},{"code":"65039","type":"CPT","modifier":"702"}],"standard_charges":[{"setting":"outpatient","modifier_code":["702"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Prec Neo Sys Kit Freestyl","code_information":[{"code":"CP17744631830815173","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599517501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valium       Tab 10mg","code_information":[{"code":"CP17744631831223674","type":"CDM"},{"code":"250","type":"RC"},{"code":"80725000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cortisporin  Sus -Tc Otic","code_information":[{"code":"CP17744631829429316","type":"CDM"},{"code":"250","type":"RC"},{"code":"63481052910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Tab 15mg","code_information":[{"code":"CP17744631830714303","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084097501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mirabegron   Tab 25mg Er","code_information":[{"code":"CP17744631830495499","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Myrbetriq    Tab 25mg","code_information":[{"code":"CP17744631830539371","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tavaborole   Sol 5%","code_information":[{"code":"CP17744631831101974","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922002012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Collagenase  Pow","code_information":[{"code":"CP17744631829404912","type":"CDM"},{"code":"250","type":"RC"},{"code":"51927287700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Modafinil    Tab 100mg","code_information":[{"code":"CP17744631830496622","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Blood Pressu Mis Monitor","code_information":[{"code":"CP17744631828932201","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295012931","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Male Sol 0.5%","code_information":[{"code":"CP17744631831138226","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505100501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Timolol Maleate 0.5% Soln","code_information":[{"code":"CP17744631831133935","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505100501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ceftazidime/ Sol D5w 2gm","code_information":[{"code":"CP17744631829172190","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime/dextrose 2gm Solr","code_information":[{"code":"CP17744631829171312","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Symbicort    Aer 160-4.5","code_information":[{"code":"CP17744631831083878","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Symbicort  Aer 160-4.5 120inh","code_information":[{"code":"CP17744631831085384","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Voriconazole Opth Soln","code_information":[{"code":"CP17744631831308770","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781046671","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Exelon       Dis 13.3/24","code_information":[{"code":"CP17744631829834599","type":"CDM"},{"code":"250","type":"RC"},{"code":"78050","type":"CPT","modifier":"315"}],"standard_charges":[{"setting":"outpatient","modifier_code":["315"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Exelon       Dis 4.6mg/24","code_information":[{"code":"CP17744631829834143","type":"CDM"},{"code":"250","type":"RC"},{"code":"78050","type":"CPT","modifier":"115"}],"standard_charges":[{"setting":"outpatient","modifier_code":["115"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Exelon       Dis 9.5mg/24","code_information":[{"code":"CP17744631829837098","type":"CDM"},{"code":"250","type":"RC"},{"code":"78050","type":"CPT","modifier":"215"}],"standard_charges":[{"setting":"outpatient","modifier_code":["215"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Exelon 4.6mg/24hr Patch","code_information":[{"code":"CP17744631829831559","type":"CDM"},{"code":"250","type":"RC"},{"code":"78050","type":"CPT","modifier":"115"}],"standard_charges":[{"setting":"outpatient","modifier_code":["115"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Exelon 9.5mg/24hr Patch","code_information":[{"code":"CP17744631829830899","type":"CDM"},{"code":"250","type":"RC"},{"code":"78050","type":"CPT","modifier":"215"}],"standard_charges":[{"setting":"outpatient","modifier_code":["215"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Tretinoin    Cap 10mg","code_information":[{"code":"CP17744631831179284","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462079201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hypodermoclysis Kit","code_information":[{"code":"CP17744631830123243","type":"CDM"},{"code":"250","type":"RC"},{"code":"20924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flovent  110mcg 120 Inh","code_information":[{"code":"CP17744631829964773","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":11,"type":"ME"}},{"description":"Flovent Hfa  Aer 110mcg","code_information":[{"code":"CP17744631829965442","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":11,"type":"ME"}},{"description":"Wynzora      Cre","code_information":[{"code":"CP17744631831385027","type":"CDM"},{"code":"250","type":"RC"},{"code":"73499000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Cre 5%","code_information":[{"code":"CP17744631828332650","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578010105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831111775","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150027701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Enstilar     Aer","code_information":[{"code":"CP17744631829781730","type":"CDM"},{"code":"250","type":"RC"},{"code":"50222030260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Knee Brace   Mis","code_information":[{"code":"CP17744631830191594","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295012475","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Pad 3/4\"x12\"","code_information":[{"code":"CP17744631830402742","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compression  Mis Stocking","code_information":[{"code":"CP17744631829413578","type":"CDM"},{"code":"250","type":"RC"},{"code":"45129020365","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Orilissa     Tab 200mg","code_information":[{"code":"CP17744631830691263","type":"CDM"},{"code":"250","type":"RC"},{"code":"74003","type":"CPT","modifier":"956"}],"standard_charges":[{"setting":"outpatient","modifier_code":["956"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Sigvaris Compression Socks M/s","code_information":[{"code":"CP17744631831016883","type":"CDM"},{"code":"250","type":"RC"},{"code":"45129020365","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ventolin Hfa Aer","code_information":[{"code":"CP17744631831261130","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ventolin Hfa Aer (60 Doses)","code_information":[{"code":"CP17744631831260559","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Ventolin Hfa Aer 200 Inh","code_information":[{"code":"CP17744631831263612","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Ventolin Hfa Aer 60 Inh","code_information":[{"code":"CP17744631831262973","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Tetrabenazin Tab 25mg","code_information":[{"code":"CP17744631831122623","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598039567","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bimatoprost  Sol 0.03%","code_information":[{"code":"CP17744631828886857","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505058304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Xtampza Er   Cap 36mg","code_information":[{"code":"CP17744631831387489","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510014010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":36,"type":"ME"}},{"description":"Knee Brace   Mis Hinged","code_information":[{"code":"CP17744631830198819","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131019187","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Tab 100mg","code_information":[{"code":"CP17744631831083612","type":"CDM"},{"code":"250","type":"RC"},{"code":"37856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Maxitrol     Sus 0.1% Op","code_information":[{"code":"CP17744631830400720","type":"CDM"},{"code":"250","type":"RC"},{"code":"78079","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mk Walker Fldng 5\"whel","code_information":[{"code":"CP17744631830498186","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922296","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Retacrit     Inj 2000unit","code_information":[{"code":"CP17744631830890740","type":"CDM"},{"code":"250","type":"RC"},{"code":"69130","type":"CPT","modifier":"510"}],"standard_charges":[{"setting":"outpatient","modifier_code":["510"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2000,"type":"UN"}},{"description":"Effexor Xr   Cap 150mg","code_information":[{"code":"CP17744631829761580","type":"CDM"},{"code":"250","type":"RC"},{"code":"80836","type":"CPT","modifier":"21"}],"standard_charges":[{"setting":"outpatient","modifier_code":["21"],"minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Vimpat       Tab 200mg","code_information":[{"code":"CP17744631831273098","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Vimpat       Tab 150mg","code_information":[{"code":"CP17744631831279662","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Xatmep       Sol 2.5mg/ml","code_information":[{"code":"CP17744631831384893","type":"CDM"},{"code":"250","type":"RC"},{"code":"52652200106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Buprenorphin Dis 7.5/hr","code_information":[{"code":"CP17744631828983775","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238150502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830402638","type":"CDM"},{"code":"250","type":"RC"},{"code":"54857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Narcan       Spr 4mg","code_information":[{"code":"CP17744631830549848","type":"CDM"},{"code":"250","type":"RC"},{"code":"69547062702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Rextovy      Spr 4/0.25ml","code_information":[{"code":"CP17744631830898020","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329366902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ML"}},{"description":"Vortex/mask  Mis Childs","code_information":[{"code":"CP17744631831302842","type":"CDM"},{"code":"250","type":"RC"},{"code":"83490051039","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":23,"gross_charge":23,"discounted_cash":23,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":23},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aquacel Ag   Mis 3/4\"x18\"","code_information":[{"code":"CP17744631828736952","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010674","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ins Degl Flx Inj 200unit","code_information":[{"code":"CP17744631830148471","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070050315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":200,"type":"UN"}},{"description":"Insulin Degludec 200 Un/ml Pen","code_information":[{"code":"CP17744631830143558","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070050315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Dermaview Transp Dressing","code_information":[{"code":"CP17744631829554286","type":"CDM"},{"code":"250","type":"RC"},{"code":"15411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"**On Indefinite Backorder**","code_information":[{"code":"CP17744631828056893","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Drizalma     Cap 20mg Dr","code_information":[{"code":"CP17744631829746867","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829103017","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687014994","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ongentys     Cap 25mg","code_information":[{"code":"CP17744631830696547","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370302502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ongentys     Cap 50mg","code_information":[{"code":"CP17744631830698727","type":"CDM"},{"code":"250","type":"RC"},{"code":"70370305002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dimethyl Fum Cap 120mg Dr","code_information":[{"code":"CP17744631829701874","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722065731","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Dimethyl Fum Cap 240mg Dr","code_information":[{"code":"CP17744631829702872","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722065832","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Maraviroc    Tab 300mg","code_information":[{"code":"CP17744631830404039","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Welchol      Pak 3.75gm","code_information":[{"code":"CP17744631831373502","type":"CDM"},{"code":"250","type":"RC"},{"code":"65597090230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Welchol 3.75gm Packets","code_information":[{"code":"CP17744631831376701","type":"CDM"},{"code":"250","type":"RC"},{"code":"65597090230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Mirvaso      Gel 0.33%","code_information":[{"code":"CP17744631830494595","type":"CDM"},{"code":"250","type":"RC"},{"code":"29959","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":33,"type":"EA"}},{"description":"Dimethyl Fum Cap 240mg Dr","code_information":[{"code":"CP17744631829707503","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729041759","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Dimethyl Fum Cap 240mg Dr","code_information":[{"code":"CP17744631829704889","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729041712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Aquacel Ag   Pad 5\"x4\"","code_information":[{"code":"CP17744631828734059","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455011051","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830069829","type":"CDM"},{"code":"250","type":"RC"},{"code":"70371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline  Cap 40mg","code_information":[{"code":"CP17744631829741427","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308066830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Motpoly Xr   Cap 200mg","code_information":[{"code":"CP17744631830505518","type":"CDM"},{"code":"250","type":"RC"},{"code":"73289006502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pennsaid     Sol 2%","code_information":[{"code":"CP17744631830747321","type":"CDM"},{"code":"250","type":"RC"},{"code":"75987004005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Fondaparinux Inj 2.5/0.5","code_information":[{"code":"CP17744631829995128","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457058210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Compressor Nebulizer","code_information":[{"code":"CP17744631829411832","type":"CDM"},{"code":"250","type":"RC"},{"code":"73796045801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Riluzole     Tab 50mg","code_information":[{"code":"CP17744631830892149","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877028660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dimethyl Fum Cap 240mg Dr","code_information":[{"code":"CP17744631829709916","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547002506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Zubsolv      Sub 11.4-2.9","code_information":[{"code":"CP17744631831418430","type":"CDM"},{"code":"250","type":"RC"},{"code":"54123011430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":114,"type":"EA"}},{"description":"Zubsolv 11.4/2.9mg Sub Tab","code_information":[{"code":"CP17744631831416625","type":"CDM"},{"code":"250","type":"RC"},{"code":"54123011430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":114,"type":"ME"}},{"description":"Chlorzoxazon Tab 750mg","code_information":[{"code":"CP17744631829220796","type":"CDM"},{"code":"250","type":"RC"},{"code":"25420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Saphris      Sub 10mg","code_information":[{"code":"CP17744631830993413","type":"CDM"},{"code":"250","type":"RC"},{"code":"45624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Saphris 10mg Subl","code_information":[{"code":"CP17744631830993994","type":"CDM"},{"code":"250","type":"RC"},{"code":"45624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Saphris 5mg Subl","code_information":[{"code":"CP17744631830997795","type":"CDM"},{"code":"250","type":"RC"},{"code":"45624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Stockg T-h Ct 30-40 Bge Ss Xl!","code_information":[{"code":"CP17744631831069179","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960227","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Periph Iv Cath 14g5-1/4","code_information":[{"code":"CP17744631830758005","type":"CDM"},{"code":"250","type":"RC"},{"code":"32982312456","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bella/opium  Sup 16.2-30","code_information":[{"code":"CP17744631828857506","type":"CDM"},{"code":"250","type":"RC"},{"code":"57470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ammonium Lac Lot 12%","code_information":[{"code":"CP17744631828497935","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802041926","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830064361","type":"CDM"},{"code":"250","type":"RC"},{"code":"70371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hydrocort Ac Sup 30mg","code_information":[{"code":"CP17744631830114899","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328012912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Januvia      Tab 25mg","code_information":[{"code":"CP17744631830185241","type":"CDM"},{"code":"250","type":"RC"},{"code":"60221","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Januvia 25mg Tabs","code_information":[{"code":"CP17744631830189114","type":"CDM"},{"code":"250","type":"RC"},{"code":"60221","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830400410","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150033001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Shoulder Immbilizer","code_information":[{"code":"CP17744631831017082","type":"CDM"},{"code":"250","type":"RC"},{"code":"73838484100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tegaderm Flm Mis 4\"x4-3/4","code_information":[{"code":"CP17744631831101941","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333162605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo G Shoulder Support","code_information":[{"code":"CP17744631830543188","type":"CDM"},{"code":"250","type":"RC"},{"code":"81933302896","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dimethyl Fum Cap 120mg Dr","code_information":[{"code":"CP17744631829708749","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651008314","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Bed Side Rail","code_information":[{"code":"CP17744631828850484","type":"CDM"},{"code":"250","type":"RC"},{"code":"63892","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine   Inj 10mg","code_information":[{"code":"CP17744631830662632","type":"CDM"},{"code":"250","type":"RC"},{"code":"78131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Imip/cila 500 Mg/100ml Ns El-j","code_information":[{"code":"CP17744631830132032","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Imipen/cilastin 1gm / 250ml Ns","code_information":[{"code":"CP17744631830136058","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Imipen/cilastin 1gm/250ml Ns","code_information":[{"code":"CP17744631830135031","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Imipenem/cil 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830131420","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Imipenem/cil Inj 500mg","code_information":[{"code":"CP17744631830138948","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Imipenem/cilast 500mg/100ml Ns","code_information":[{"code":"CP17744631830130160","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Bimatoprost  Sol 0.03%","code_information":[{"code":"CP17744631828888867","type":"CDM"},{"code":"250","type":"RC"},{"code":"78162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Dorzol/timol Sol 2-0.5%op","code_information":[{"code":"CP17744631829726541","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862094601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Hypodermoclysis Kit","code_information":[{"code":"CP17744631830120706","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Aqua-c Hydraition Kit","code_information":[{"code":"CP17744631830172157","type":"CDM"},{"code":"250","type":"RC"},{"code":"25003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Aqua-c Hydration Sys","code_information":[{"code":"CP17744631830177503","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Basaglar     Inj Tempo Pn","code_information":[{"code":"CP17744631828833437","type":"CDM"},{"code":"250","type":"RC"},{"code":"28214","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Taclonex     Sus","code_information":[{"code":"CP17744631831091185","type":"CDM"},{"code":"250","type":"RC"},{"code":"50222050106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Precision Flow 24 Ex Tube","code_information":[{"code":"CP17744631830818337","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"024","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":22,"discounted_cash":22}]},{"description":"Imiquimod    Cre 3.75%","code_information":[{"code":"CP17744631830132698","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672417406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Tobramycin 140mg /100ml Ns","code_information":[{"code":"CP17744631831143147","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":140,"type":"ME"}},{"description":"Tobramycin 60mg/100ml Ns","code_information":[{"code":"CP17744631831149723","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Afluria      Inj 2024-25","code_information":[{"code":"CP17744631828366389","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332002403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":2024,"type":"EA"}},{"description":"Afluria Pfs 24/25 0.5ml Dose","code_information":[{"code":"CP17744631828368456","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332002403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Afluria Syringe 2024-2025","code_information":[{"code":"CP17744631828369922","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332002403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hernia Truss Medium","code_information":[{"code":"CP17744631830086019","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189023281","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Port Access Miniloc","code_information":[{"code":"CP17744631830177973","type":"CDM"},{"code":"250","type":"RC"},{"code":"80174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Port Access Kit","code_information":[{"code":"CP17744631830785967","type":"CDM"},{"code":"250","type":"RC"},{"code":"80174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Risedron Sod Tab 35mg Dr","code_information":[{"code":"CP17744631830893337","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304044009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Monistat 1   Kit 1200/2%","code_information":[{"code":"CP17744631830502898","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736044180","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":18,"maximum":22,"gross_charge":22,"discounted_cash":22,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":22},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ambien       Tab 10mg","code_information":[{"code":"CP17744631828468958","type":"CDM"},{"code":"250","type":"RC"},{"code":"24542","type":"CPT","modifier":"131"}],"standard_charges":[{"setting":"outpatient","modifier_code":["131"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ambien       Tab 5mg","code_information":[{"code":"CP17744631828466073","type":"CDM"},{"code":"250","type":"RC"},{"code":"24540","type":"CPT","modifier":"131"}],"standard_charges":[{"setting":"outpatient","modifier_code":["131"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ambien Cr    Tab 12.5mg","code_information":[{"code":"CP17744631828467098","type":"CDM"},{"code":"250","type":"RC"},{"code":"24552","type":"CPT","modifier":"131"}],"standard_charges":[{"setting":"outpatient","modifier_code":["131"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Qvar Rediha Aer 40mcg 120inh","code_information":[{"code":"CP17744631830879465","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310030240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Qvar Redihal Aer 40mcg","code_information":[{"code":"CP17744631830870320","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310030240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Qvar Redihaler 40mcg/act","code_information":[{"code":"CP17744631830875759","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310030240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Mirabegron   Tab 50mg Er","code_information":[{"code":"CP17744631830499237","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710116003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Myrbetriq    Tab 50mg","code_information":[{"code":"CP17744631830530023","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710116003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bpco         Oin","code_information":[{"code":"CP17744631828942123","type":"CDM"},{"code":"250","type":"RC"},{"code":"71351001460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829437901","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin-1000mcg/ml- Inj","code_information":[{"code":"CP17744631829433324","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Lansoprazole 3mg/ml Suspension","code_information":[{"code":"CP17744631830216464","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382077277","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Lansoprazole Tab 30mg Odt","code_information":[{"code":"CP17744631830211008","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382077277","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Rectiv       Oin 0.4%","code_information":[{"code":"CP17744631830883318","type":"CDM"},{"code":"250","type":"RC"},{"code":"58914030180","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Transderm-sc Dis 1.5mg","code_information":[{"code":"CP17744631831167192","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019055303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Transderm-sc Dis 1mg/3day","code_information":[{"code":"CP17744631831162229","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019055304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Transderm-sc Dis 1mg/3day","code_information":[{"code":"CP17744631831162147","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019055303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Vimpat       Tab 100mg","code_information":[{"code":"CP17744631831279787","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Buprenorphin Dis 10mcg/hr","code_information":[{"code":"CP17744631828971023","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238120302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ammonium Lac Lot 12%","code_information":[{"code":"CP17744631828496053","type":"CDM"},{"code":"250","type":"RC"},{"code":"90459","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Breyna       Aer 80/4.5","code_information":[{"code":"CP17744631828949624","type":"CDM"},{"code":"250","type":"RC"},{"code":"37875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Mupirocin    Pow","code_information":[{"code":"CP17744631830528071","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779254503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inpefa       Tab 200mg","code_information":[{"code":"CP17744631830144037","type":"CDM"},{"code":"250","type":"RC"},{"code":"70183022130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Feraheme 510mg/100ml Ns","code_information":[{"code":"CP17744631829859444","type":"CDM"},{"code":"250","type":"RC"},{"code":"78131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":510,"type":"ME"}},{"description":"Ferumoxytol  Inj 510/17ml","code_information":[{"code":"CP17744631829866350","type":"CDM"},{"code":"250","type":"RC"},{"code":"78131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":17,"type":"ML"}},{"description":"Tretinoin    Cap 10mg","code_information":[{"code":"CP17744631831174841","type":"CDM"},{"code":"250","type":"RC"},{"code":"55508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Advair Hfa   Aer 45/21","code_information":[{"code":"CP17744631828354239","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Advair Hfa Aer 45/21 60inh","code_information":[{"code":"CP17744631828366286","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Trimethobenz Cap 300mg","code_information":[{"code":"CP17744631831194125","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135077330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Jobst Anti-emb Knee-hi Med/lon","code_information":[{"code":"CP17744631830180453","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664014622","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lonhala Magn Sol 25mcg","code_information":[{"code":"CP17744631830351531","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402020100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Phenoxybenza Cap 10mg","code_information":[{"code":"CP17744631830761447","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993006602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Relief/knee  Mis Large","code_information":[{"code":"CP17744631830881029","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664014738","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Relief/knee  Mis Large","code_information":[{"code":"CP17744631830888030","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664014622","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Relief/knee  Mis Small","code_information":[{"code":"CP17744631830888459","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664014620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Relief/knee  Mis X-large","code_information":[{"code":"CP17744631830882443","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664014624","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sodium Chlor Neb 3%","code_information":[{"code":"CP17744631831047231","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204002260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Cosopt       Sol 22.3-6.8","code_information":[{"code":"CP17744631829420890","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478060510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Abaca/lamivu Tab 600-300","code_information":[{"code":"CP17744631828108935","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180028806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Abaca/lamivu Tab 600-300","code_information":[{"code":"CP17744631828101125","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097036202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Abaca/lamivu Tab 600-300m","code_information":[{"code":"CP17744631828100705","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097036202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Abacav/lamiv 600/300mg Tabs","code_information":[{"code":"CP17744631828107629","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097036202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Advair Hfa   Aer 45/21","code_information":[{"code":"CP17744631828355547","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Advair Hfa Aer 45/21 120inh","code_information":[{"code":"CP17744631828365137","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Aspercreme   Pad Lid 4%","code_information":[{"code":"CP17744631828764663","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167005847","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xtampza Er   Cap 13.5mg","code_information":[{"code":"CP17744631831389057","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510011510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":135,"type":"ME"}},{"description":"Alomide      Sol 0.1% Op","code_information":[{"code":"CP17744631828430369","type":"CDM"},{"code":"250","type":"RC"},{"code":"78073","type":"CPT","modifier":"610"}],"standard_charges":[{"setting":"outpatient","modifier_code":["610"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ibandronate  Tab 150mg","code_information":[{"code":"CP17744631830127599","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505279500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Nucynta      Tab 100mg","code_information":[{"code":"CP17744631830644029","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ibandronate  Tab 150mg","code_information":[{"code":"CP17744631830126953","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111057543","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ibandronate  Tab 150mg","code_information":[{"code":"CP17744631830126075","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111057503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ibandronate  Tab 150mg","code_information":[{"code":"CP17744631830128896","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342015053","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Trulance     Tab 3mg","code_information":[{"code":"CP17744631831191311","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649000330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Keppra 1000mg Tabs","code_information":[{"code":"CP17744631830182651","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474059766","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Effexor Xr   Cap 75mg","code_information":[{"code":"CP17744631829760033","type":"CDM"},{"code":"250","type":"RC"},{"code":"80833","type":"CPT","modifier":"21"}],"standard_charges":[{"setting":"outpatient","modifier_code":["21"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Effexor Xr   Cap 75mg","code_information":[{"code":"CP17744631829760945","type":"CDM"},{"code":"250","type":"RC"},{"code":"80833","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Acetylcyst   Sol 20%","code_information":[{"code":"CP17744631828305595","type":"CDM"},{"code":"250","type":"RC"},{"code":"51776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Acetylcysteine 10% Ophth Drop","code_information":[{"code":"CP17744631828305184","type":"CDM"},{"code":"250","type":"RC"},{"code":"51776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 20% Soln Vial","code_information":[{"code":"CP17744631828317104","type":"CDM"},{"code":"250","type":"RC"},{"code":"51776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Fycompa      Tab 2mg","code_information":[{"code":"CP17744631830016538","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856027230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Fycompa      Tab 2mg","code_information":[{"code":"CP17744631830012885","type":"CDM"},{"code":"250","type":"RC"},{"code":"69616027230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Docosanol    Cre 10%","code_information":[{"code":"CP17744631829717182","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269098135","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Namzaric     Cap 14-10mg","code_information":[{"code":"CP17744631830539434","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Namzaric     Cap 21-10mg","code_information":[{"code":"CP17744631830538735","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Namzaric     Cap 28-10mg","code_information":[{"code":"CP17744631830534408","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Namzaric     Cap 7-10mg","code_information":[{"code":"CP17744631830537058","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Namzaric 14-10mg Caps","code_information":[{"code":"CP17744631830532698","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Namzaric 28-10mg Caps","code_information":[{"code":"CP17744631830535689","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Brimonidine  Sol 0.15%","code_information":[{"code":"CP17744631828958686","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314014405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Clobazam     Tab 10mg","code_information":[{"code":"CP17744631829268719","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Androderm    Dis 4mg/24hr","code_information":[{"code":"CP17744631828538175","type":"CDM"},{"code":"250","type":"RC"},{"code":"23599","type":"CPT","modifier":"230"}],"standard_charges":[{"setting":"outpatient","modifier_code":["230"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Inpefa       Tab 200mg","code_information":[{"code":"CP17744631830142476","type":"CDM"},{"code":"250","type":"RC"},{"code":"70183022030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Vimpat       Tab 150mg","code_information":[{"code":"CP17744631831272972","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Vimpat       Tab 200mg","code_information":[{"code":"CP17744631831272058","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Vimpat 150mg Tabs","code_information":[{"code":"CP17744631831274752","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Vimpat 200mg Tabs","code_information":[{"code":"CP17744631831271629","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Flucytosine  Cap 250mg","code_information":[{"code":"CP17744631829963590","type":"CDM"},{"code":"250","type":"RC"},{"code":"54042","type":"CPT","modifier":"725"}],"standard_charges":[{"setting":"outpatient","modifier_code":["725"],"minimum":17,"maximum":21,"gross_charge":21,"discounted_cash":21,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":21},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Demeclocycl  Tab 300mg","code_information":[{"code":"CP17744631829554777","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806014448","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Proctofoam   Aer Hc 1%","code_information":[{"code":"CP17744631830836091","type":"CDM"},{"code":"250","type":"RC"},{"code":"37682","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proctofoam Hc 14 Doses","code_information":[{"code":"CP17744631830838868","type":"CDM"},{"code":"250","type":"RC"},{"code":"37682","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Spr 5mg/act","code_information":[{"code":"CP17744631831088280","type":"CDM"},{"code":"250","type":"RC"},{"code":"52718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gentamicin   Cre 0.1%","code_information":[{"code":"CP17744631830023319","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xarelto      Tab 10mg","code_information":[{"code":"CP17744631831389900","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Xarelto      Tab 10mg","code_information":[{"code":"CP17744631831387192","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Xarelto      Tab 10mg","code_information":[{"code":"CP17744631831388133","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Xarelto      Tab 20mg","code_information":[{"code":"CP17744631831383916","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057989","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Xarelto      Tab 20mg","code_information":[{"code":"CP17744631831389312","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Xarelto 10mg Tabs","code_information":[{"code":"CP17744631831381227","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Xarelto Star Tab 15/20mg","code_information":[{"code":"CP17744631831380756","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058451","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Stocking K-h Small 30-40","code_information":[{"code":"CP17744631831072565","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566414630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828758970","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714014601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Nystatin 100000unit/ml Susp","code_information":[{"code":"CP17744631830654664","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094059959","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":100000,"type":"UN"}},{"description":"Hysingla Er  Tab 30 Mg","code_information":[{"code":"CP17744631830121203","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011027260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aspruzyo Spr Gra 500mg","code_information":[{"code":"CP17744631828770515","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335062460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Adzenys Xr   Tab 18.8mg","code_information":[{"code":"CP17744631828362755","type":"CDM"},{"code":"250","type":"RC"},{"code":"70165003030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":188,"type":"ME"}},{"description":"Solu-cortef  Inj 100mg","code_information":[{"code":"CP17744631831054832","type":"CDM"},{"code":"250","type":"RC"},{"code":"90825","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830408533","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762453701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Stock Bl-kn Ct 30-40 Bg","code_information":[{"code":"CP17744631831062174","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960189","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Symbicort    Aer 80-4.5","code_information":[{"code":"CP17744631831080985","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Symbicort  Aer 80-4.5 120inh","code_information":[{"code":"CP17744631831089334","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Symbicort    Aer 80-4.5","code_information":[{"code":"CP17744631831081726","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Symbicort  Aer 80-4.5 60inh","code_information":[{"code":"CP17744631831080171","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Buprenorphin Sub 2mg","code_information":[{"code":"CP17744631828982087","type":"CDM"},{"code":"250","type":"RC"},{"code":"54017","type":"CPT","modifier":"613"}],"standard_charges":[{"setting":"outpatient","modifier_code":["613"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Cefotetan    Inj 1gm","code_information":[{"code":"CP17744631829171703","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323038510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefotetan    Inj 1gm/10ml","code_information":[{"code":"CP17744631829176783","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323038510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefotetan 1gm/50ml Ns","code_information":[{"code":"CP17744631829179565","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323038510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefotetan 1gm-solr","code_information":[{"code":"CP17744631829176987","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323038510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Lamictal Xr  Kit","code_information":[{"code":"CP17744631830209604","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830404568","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714002801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Surgilast Tubular 25yds","code_information":[{"code":"CP17744631831082011","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917018575","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lipitor      Tab 20mg","code_information":[{"code":"CP17744631830347829","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151015677","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lipitor      Tab 40mg","code_information":[{"code":"CP17744631830346108","type":"CDM"},{"code":"250","type":"RC"},{"code":"71015","type":"CPT","modifier":"723"}],"standard_charges":[{"setting":"outpatient","modifier_code":["723"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lipitor      Tab 40mg","code_information":[{"code":"CP17744631830340880","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151015777","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lipitor      Tab 80mg","code_information":[{"code":"CP17744631830344688","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151015877","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Xigduo Xr    Tab 10-1000","code_information":[{"code":"CP17744631831385708","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Xigduo Xr    Tab 10-500mg","code_information":[{"code":"CP17744631831382337","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Xigduo Xr    Tab 5-500mg","code_information":[{"code":"CP17744631831382976","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Xigduo Xr Tab 10-1000","code_information":[{"code":"CP17744631831381559","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Invokana     Tab 100mg","code_information":[{"code":"CP17744631830157612","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458014090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Invokana     Tab 100mg","code_information":[{"code":"CP17744631830155097","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458014030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Invokana     Tab 300mg","code_information":[{"code":"CP17744631830150840","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458014190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Hydrofera    Pad Blue 6x6","code_information":[{"code":"CP17744631830114909","type":"CDM"},{"code":"250","type":"RC"},{"code":"8573016614","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bath/shower  Mis Seat","code_information":[{"code":"CP17744631828841803","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601000005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pirfenidone  Tab 801mg","code_information":[{"code":"CP17744631830784172","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332048090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":801,"type":"ME"}},{"description":"Pirfenidone  Tab 801mg","code_information":[{"code":"CP17744631830784334","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097098805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":801,"type":"ME"}},{"description":"Pirfenidone  Tab 801mg","code_information":[{"code":"CP17744631830780727","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219164109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":801,"type":"ME"}},{"description":"Flonase Sens Sus 27.5mcg","code_information":[{"code":"CP17744631829963356","type":"CDM"},{"code":"250","type":"RC"},{"code":"13506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":275,"type":"ME"}},{"description":"Flonase Sens Sus 27.5mcg","code_information":[{"code":"CP17744631829967432","type":"CDM"},{"code":"250","type":"RC"},{"code":"13506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":275,"type":"ME"}},{"description":"Actos        Tab 30mg","code_information":[{"code":"CP17744631828325092","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764030114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Clozapine    Tab 200/odt","code_information":[{"code":"CP17744631829399709","type":"CDM"},{"code":"250","type":"RC"},{"code":"93537","type":"CPT","modifier":"784"}],"standard_charges":[{"setting":"outpatient","modifier_code":["784"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Lacosamide   Tab 150mg","code_information":[{"code":"CP17744631830205579","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877073560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Rightest Sys Kit Gm100","code_information":[{"code":"CP17744631830896807","type":"CDM"},{"code":"250","type":"RC"},{"code":"8539010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alomide      Sol 0.1% Op","code_information":[{"code":"CP17744631828430230","type":"CDM"},{"code":"250","type":"RC"},{"code":"65034","type":"CPT","modifier":"510"}],"standard_charges":[{"setting":"outpatient","modifier_code":["510"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wrist Splint -Rt","code_information":[{"code":"CP17744631831383977","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290208609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Depo-medrol  Inj 80mg/ml","code_information":[{"code":"CP17744631829555966","type":"CDM"},{"code":"250","type":"RC"},{"code":"93475","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Topiramate   Cap Er 150mg","code_information":[{"code":"CP17744631831153331","type":"CDM"},{"code":"250","type":"RC"},{"code":"83210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"One Touch    Kit Verio Fl","code_information":[{"code":"CP17744631830686982","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885004401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Kit Verio Fl","code_information":[{"code":"CP17744631830687951","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885004401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830156055","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335075652","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Gel  Sol 0.5% Op","code_information":[{"code":"CP17744631831137186","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598074811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cefepime     Inj 1gm","code_information":[{"code":"CP17744631829167229","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1g/50ml Dex","code_information":[{"code":"CP17744631829167917","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1gm / Dextrose 50ml","code_information":[{"code":"CP17744631829165224","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime/dex Inj 1gm","code_information":[{"code":"CP17744631829170729","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriax/dex Inj 1gm","code_information":[{"code":"CP17744631829170566","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Dex","code_information":[{"code":"CP17744631829183817","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Clozapine     Tab 200/odt","code_information":[{"code":"CP17744631829394462","type":"CDM"},{"code":"250","type":"RC"},{"code":"93537","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Clozapine    Tab 200/odt","code_information":[{"code":"CP17744631829399438","type":"CDM"},{"code":"250","type":"RC"},{"code":"93537","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Bromfenac    Dro 0.075%","code_information":[{"code":"CP17744631828957752","type":"CDM"},{"code":"250","type":"RC"},{"code":"49708075541","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 40mg Cr","code_information":[{"code":"CP17744631830721884","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Oxycontin    Tab 40mg Er","code_information":[{"code":"CP17744631830728630","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Oxycontin Er 40mg Tabs","code_information":[{"code":"CP17744631830729449","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011044010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nyamyc       Pow 100000","code_information":[{"code":"CP17744631830647819","type":"CDM"},{"code":"250","type":"RC"},{"code":"83204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nyamyc 100,000iu Powder","code_information":[{"code":"CP17744631830648686","type":"CDM"},{"code":"250","type":"RC"},{"code":"83204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":100000,"type":"F2"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828943001","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Cadd Administration Set","code_information":[{"code":"CP17744631829057038","type":"CDM"},{"code":"250","type":"RC"},{"code":"21732","type":"CPT","modifier":"224"}],"standard_charges":[{"setting":"outpatient","modifier_code":["224"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Infed        Inj 50mg/ml","code_information":[{"code":"CP17744631830149397","type":"CDM"},{"code":"250","type":"RC"},{"code":"23608","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin   Inj 750mg","code_information":[{"code":"CP17744631831230142","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750mg/150ml Dex","code_information":[{"code":"CP17744631831241368","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750mg/150ml Ns","code_information":[{"code":"CP17744631831247699","type":"CDM"},{"code":"250","type":"RC"},{"code":"33835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Ocusoft Lid  Pad Scrub Pl","code_information":[{"code":"CP17744631830662008","type":"CDM"},{"code":"250","type":"RC"},{"code":"15718010430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phytonadione 5mg Tabs","code_information":[{"code":"CP17744631830769506","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714097301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830765001","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714097301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":16,"maximum":20,"gross_charge":20,"discounted_cash":20,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":20},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Belbuca      Mis 900mcg","code_information":[{"code":"CP17744631828852365","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Hydroxyz Hcl Inj 25mg/ml","code_information":[{"code":"CP17744631830112023","type":"CDM"},{"code":"250","type":"RC"},{"code":"51742","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Trijardy Xr  Tab","code_information":[{"code":"CP17744631831193984","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trijardy Xr 25-5-1000 Tab","code_information":[{"code":"CP17744631831193408","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Abilify      Tab 10mg","code_information":[{"code":"CP17744631828119874","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148000813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Abilify      Tab 15mg","code_information":[{"code":"CP17744631828116592","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148000913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Abilify 5mg Tabs","code_information":[{"code":"CP17744631828117745","type":"CDM"},{"code":"250","type":"RC"},{"code":"59148000713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Enteragam    Pow 5gm","code_information":[{"code":"CP17744631829791438","type":"CDM"},{"code":"250","type":"RC"},{"code":"53703010003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Nebulizer Rite-neb5","code_information":[{"code":"CP17744631830542295","type":"CDM"},{"code":"250","type":"RC"},{"code":"81506708013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Pirfenidone  Tab 801mg","code_information":[{"code":"CP17744631830784849","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603025901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":801,"type":"ME"}},{"description":"Veozah       Tab 45mg","code_information":[{"code":"CP17744631831267391","type":"CDM"},{"code":"250","type":"RC"},{"code":"46926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Pirfenidone  Tab 801mg","code_information":[{"code":"CP17744631830781456","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722087390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":801,"type":"ME"}},{"description":"Fluconazole  Sus 40mg/ml","code_information":[{"code":"CP17744631829965077","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Yuvafem      Tab 10mcg","code_information":[{"code":"CP17744631831388075","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162022621","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Vimpat       Tab 100mg","code_information":[{"code":"CP17744631831274762","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Vimpat 100mg Tabs","code_information":[{"code":"CP17744631831277391","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Invega       Tab 9mg","code_information":[{"code":"CP17744631830156326","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458055201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Invega 9mg Tabs","code_information":[{"code":"CP17744631830151589","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458055201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Flovent Hfa  Aer 44mcg","code_information":[{"code":"CP17744631829960680","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":44,"type":"ME"}},{"description":"Flovent Hfa Aer 44mcg 120 Inh","code_information":[{"code":"CP17744631829969754","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":44,"type":"ME"}},{"description":"Bromfenac    Dro 0.07% Op","code_information":[{"code":"CP17744631828954923","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180043302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Advair Hfa Aer 45/21 120inh","code_information":[{"code":"CP17744631828367770","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008696","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Diclofenac   Gel 1%","code_information":[{"code":"CP17744631829591378","type":"CDM"},{"code":"250","type":"RC"},{"code":"76282066339","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flutic/salme Aer 45-21 120inh","code_information":[{"code":"CP17744631829987599","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008696","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Flutic/salme Aer 45-21mcg","code_information":[{"code":"CP17744631829982354","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993008696","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829268039","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238153205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluphenazine Inj 2.5mg/ml","code_information":[{"code":"CP17744631829979261","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323028110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bd Posiflush Inj 0.9%","code_information":[{"code":"CP17744631828844019","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253011130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Norml Saline Inj Iv Flush","code_information":[{"code":"CP17744631830572039","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253011130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Silver Dressing 6x6","code_information":[{"code":"CP17744631831011695","type":"CDM"},{"code":"250","type":"RC"},{"code":"11623","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Moxifloxacin Tab 400mg","code_information":[{"code":"CP17744631830519844","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Aciphex      Tab 20mg","code_information":[{"code":"CP17744631828324234","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856024330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Prucalopride Tab 2mg","code_information":[{"code":"CP17744631830852093","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954059710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Cabtreo      Gel","code_information":[{"code":"CP17744631829054989","type":"CDM"},{"code":"250","type":"RC"},{"code":"18700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kenalog-80   Inj","code_information":[{"code":"CP17744631830185979","type":"CDM"},{"code":"250","type":"RC"},{"code":"30315","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Nafcillin    Inj 2gm","code_information":[{"code":"CP17744631830538216","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567022210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Nafcillin 2g/100ml Ns","code_information":[{"code":"CP17744631830530980","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567022210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830821183","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Blood Press Mntr Wrist","code_information":[{"code":"CP17744631828935259","type":"CDM"},{"code":"250","type":"RC"},{"code":"45717000418","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metformin    Tab 1000 Er","code_information":[{"code":"CP17744631830437065","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714093901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Belbuca      Mis 750mcg","code_information":[{"code":"CP17744631828859973","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830152865","type":"CDM"},{"code":"250","type":"RC"},{"code":"48702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gelocast     Mis 4\"x10yd","code_information":[{"code":"CP17744631830027985","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664001053","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Unna Boot 4\"x10yd","code_information":[{"code":"CP17744631831215331","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664001053","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tresiba Flex 200 Units/ml 3ml","code_information":[{"code":"CP17744631831173438","type":"CDM"},{"code":"250","type":"RC"},{"code":"16925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":200,"type":"UN"}},{"description":"Tresiba Flex Inj 200unit","code_information":[{"code":"CP17744631831173869","type":"CDM"},{"code":"250","type":"RC"},{"code":"16925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":200,"type":"UN"}},{"description":"Cefoxitin    Inj 1gm","code_information":[{"code":"CP17744631829176190","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Qtern        Tab 10-5mg","code_information":[{"code":"CP17744631830869303","type":"CDM"},{"code":"250","type":"RC"},{"code":"31067","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Qtern        Tab 5-5mg","code_information":[{"code":"CP17744631830865398","type":"CDM"},{"code":"250","type":"RC"},{"code":"31067","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Linzess      Cap 72mcg","code_information":[{"code":"CP17744631830342876","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":72,"type":"ME"}},{"description":"Azelex       Cre 20%","code_information":[{"code":"CP17744631828809795","type":"CDM"},{"code":"250","type":"RC"},{"code":"16110086930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Edarbi       Tab 80mg","code_information":[{"code":"CP17744631829765930","type":"CDM"},{"code":"250","type":"RC"},{"code":"60631008030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Spiriva      Spr 2.5mcg","code_information":[{"code":"CP17744631831053044","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva Resp 2.5mcg (10 Inh)","code_information":[{"code":"CP17744631831059538","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva Respimat-2.5mcg/act-ae","code_information":[{"code":"CP17744631831055411","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spiriva Spr 2.5mcg (Sm)","code_information":[{"code":"CP17744631831055137","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Walker Flding 5\" Wheel","code_information":[{"code":"CP17744631831305872","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922299","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Horizant     Tab 300mg Er","code_information":[{"code":"CP17744631830082538","type":"CDM"},{"code":"250","type":"RC"},{"code":"53451010301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Horizant     Tab 600mg Er","code_information":[{"code":"CP17744631830087467","type":"CDM"},{"code":"250","type":"RC"},{"code":"53451010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Voltaren     Gel 1% Arthr","code_information":[{"code":"CP17744631831301659","type":"CDM"},{"code":"250","type":"RC"},{"code":"67815","type":"CPT","modifier":"203"}],"standard_charges":[{"setting":"outpatient","modifier_code":["203"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kenalog-80   Inj","code_information":[{"code":"CP17744631830186394","type":"CDM"},{"code":"250","type":"RC"},{"code":"30315","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Kenalog-80   Inj 80mg/ml","code_information":[{"code":"CP17744631830185081","type":"CDM"},{"code":"250","type":"RC"},{"code":"30315","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Fondaparinux Inj 2.5/0.5","code_information":[{"code":"CP17744631829993719","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Stocking Knee-high Md","code_information":[{"code":"CP17744631831077941","type":"CDM"},{"code":"250","type":"RC"},{"code":"3870393017","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clozapine     Tab 150/odt","code_information":[{"code":"CP17744631829397379","type":"CDM"},{"code":"250","type":"RC"},{"code":"93537","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Clozapine    Tab 150/odt","code_information":[{"code":"CP17744631829399643","type":"CDM"},{"code":"250","type":"RC"},{"code":"93537","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Aquacel Ag   Pad 4x5\"","code_information":[{"code":"CP17744631828737992","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455014564","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lexette      Aer 0.05%","code_information":[{"code":"CP17744631830328604","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862060450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Novolin      Inj 70/30 Fp","code_information":[{"code":"CP17744631830576255","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolin      Inj Flexpen","code_information":[{"code":"CP17744631830579101","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Novolin 70/30 Flexpen","code_information":[{"code":"CP17744631830578835","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolin 70/30 Flexpen 3ml","code_information":[{"code":"CP17744631830579085","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Novolin 70/30 Flexpen Inj","code_information":[{"code":"CP17744631830575189","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolin 70/30 Inj Fp","code_information":[{"code":"CP17744631830573731","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolin N    Inj 100 Unit","code_information":[{"code":"CP17744631830571386","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolin N 100 Unit/ml Pen 3ml","code_information":[{"code":"CP17744631830579486","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolin R    Inj 100 Unit","code_information":[{"code":"CP17744631830570672","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolin R 100 Units/ml Pen 3ml","code_information":[{"code":"CP17744631830576015","type":"CDM"},{"code":"250","type":"RC"},{"code":"16930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Sumatriptan  Inj 6mg/0.5","code_information":[{"code":"CP17744631831088229","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150017301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Systane Ultr Sol","code_information":[{"code":"CP17744631831092844","type":"CDM"},{"code":"250","type":"RC"},{"code":"65143","type":"CPT","modifier":"141"}],"standard_charges":[{"setting":"outpatient","modifier_code":["141"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cipro/fluoc  Dro Pf","code_information":[{"code":"CP17744631829235522","type":"CDM"},{"code":"250","type":"RC"},{"code":"42195012814","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xolegel      Gel 2%","code_information":[{"code":"CP17744631831385639","type":"CDM"},{"code":"250","type":"RC"},{"code":"16110008045","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Effexor Xr   Cap 37.5mg","code_information":[{"code":"CP17744631829768290","type":"CDM"},{"code":"250","type":"RC"},{"code":"80837","type":"CPT","modifier":"21"}],"standard_charges":[{"setting":"outpatient","modifier_code":["21"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Effexor Xr   Cap 37.5mg","code_information":[{"code":"CP17744631829760655","type":"CDM"},{"code":"250","type":"RC"},{"code":"80837","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Hydrocort    Cre 1%","code_information":[{"code":"CP17744631830107835","type":"CDM"},{"code":"250","type":"RC"},{"code":"31601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15,"maximum":19,"gross_charge":19,"discounted_cash":19,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":19},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fetzima      Cap 120mg","code_information":[{"code":"CP17744631829947598","type":"CDM"},{"code":"250","type":"RC"},{"code":"45622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Fetzima      Cap 20mg","code_information":[{"code":"CP17744631829941001","type":"CDM"},{"code":"250","type":"RC"},{"code":"45622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fetzima      Cap 40mg","code_information":[{"code":"CP17744631829945730","type":"CDM"},{"code":"250","type":"RC"},{"code":"45622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fetzima      Cap 80mg","code_information":[{"code":"CP17744631829946529","type":"CDM"},{"code":"250","type":"RC"},{"code":"45622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Methylphenid Tab 72mg Er","code_information":[{"code":"CP17744631830457552","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":72,"type":"ME"}},{"description":"Xtampza Er   Cap 27mg","code_information":[{"code":"CP17744631831387325","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510013010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":27,"type":"ME"}},{"description":"Rezvoglar    Inj 100ut/ml","code_information":[{"code":"CP17744631830895710","type":"CDM"},{"code":"250","type":"RC"},{"code":"28980","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Rezvoglar 100 Unit/ml Pen 3ml","code_information":[{"code":"CP17744631830894354","type":"CDM"},{"code":"250","type":"RC"},{"code":"28980","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Xeroform Pet Pad 4x4 Dres","code_information":[{"code":"CP17744631831383669","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784030531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dorzol/timol Sol 2-0.5%op","code_information":[{"code":"CP17744631829725962","type":"CDM"},{"code":"250","type":"RC"},{"code":"71921022610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Farxiga      Tab 10mg","code_information":[{"code":"CP17744631829844403","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Yupelri      Sol","code_information":[{"code":"CP17744631831387000","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502080693","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Yupelri 175mcg/3ml Neb Soln","code_information":[{"code":"CP17744631831383064","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502080693","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":175,"type":"ME"}},{"description":"Tazorac      Gel 0.1%","code_information":[{"code":"CP17744631831105830","type":"CDM"},{"code":"250","type":"RC"},{"code":"16110004230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epsolay      Cre 5%","code_information":[{"code":"CP17744631829793013","type":"CDM"},{"code":"250","type":"RC"},{"code":"29958","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Micafungin 50 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830475675","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Steglujan    Tab 15-100mg","code_information":[{"code":"CP17744631831064128","type":"CDM"},{"code":"250","type":"RC"},{"code":"65368","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Steglujan 5/100mg Tab","code_information":[{"code":"CP17744631831068248","type":"CDM"},{"code":"250","type":"RC"},{"code":"65367","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxcarbazepin Tab 600mg Er","code_information":[{"code":"CP17744631830703456","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241030601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Wrist Splint Universal","code_information":[{"code":"CP17744631831387303","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189069803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dronabinol   Cap 5mg","code_information":[{"code":"CP17744631829741559","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877075460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Loteprednol  Sus 0.5%","code_information":[{"code":"CP17744631830372636","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485066505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Januvia      Tab 50mg","code_information":[{"code":"CP17744631830189283","type":"CDM"},{"code":"250","type":"RC"},{"code":"60112","type":"CPT","modifier":"54"}],"standard_charges":[{"setting":"outpatient","modifier_code":["54"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Januvia 50mg Tabs","code_information":[{"code":"CP17744631830182033","type":"CDM"},{"code":"250","type":"RC"},{"code":"60112","type":"CPT","modifier":"54"}],"standard_charges":[{"setting":"outpatient","modifier_code":["54"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ofloxacin    Tab 400mg","code_information":[{"code":"CP17744631830664409","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834020150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Minivelle    Dis 0.0375mg","code_information":[{"code":"CP17744631830482876","type":"CDM"},{"code":"250","type":"RC"},{"code":"68968663708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Metformin    Tab 1000 Er","code_information":[{"code":"CP17744631830431942","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462052190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Metformin    Tab 1000 Er","code_information":[{"code":"CP17744631830432641","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180033909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Metformin    Tab 1000 Er","code_information":[{"code":"CP17744631830437085","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241024190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Metformn Mod Tab 1000 Er","code_information":[{"code":"CP17744631830447578","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241024190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Adefov Dipiv Tab 10mg","code_information":[{"code":"CP17744631828353066","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505394703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Anecream     Kit 4%","code_information":[{"code":"CP17744631828533820","type":"CDM"},{"code":"250","type":"RC"},{"code":"24357070107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol    Cre 0.01%","code_information":[{"code":"CP17744631829818942","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802009735","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nebulizer    Mis Ultrason","code_information":[{"code":"CP17744631830548386","type":"CDM"},{"code":"250","type":"RC"},{"code":"38673006610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine   Inj 10mg","code_information":[{"code":"CP17744631830667566","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150030801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Piper/tazo 4.5 Gm/100 Ml D5w","code_information":[{"code":"CP17744631830770827","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazo 4.5 Gm/100ml Ns Mb","code_information":[{"code":"CP17744631830777696","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazoba Inj 4-0.5gm","code_information":[{"code":"CP17744631830786752","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Piper/tazobac 4.5 Gm/100 Ml Ns","code_information":[{"code":"CP17744631830780714","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazobac 4.5g/100ml Ns","code_information":[{"code":"CP17744631830781627","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazobac 4.5g/100ml Ns Mb","code_information":[{"code":"CP17744631830789114","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Trintellix   Tab 10mg","code_information":[{"code":"CP17744631831197074","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764073030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Trintellix   Tab 5mg","code_information":[{"code":"CP17744631831196617","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764072030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Trintellix 10mg Tabs","code_information":[{"code":"CP17744631831198153","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764073030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Trintellix 5mg Tabs","code_information":[{"code":"CP17744631831190492","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764072030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Belbuca      Mis 600mcg","code_information":[{"code":"CP17744631828852177","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Silenor 3mg Tabs","code_information":[{"code":"CP17744631831019788","type":"CDM"},{"code":"250","type":"RC"},{"code":"42847010330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Silenor 6mg Tabs","code_information":[{"code":"CP17744631831014202","type":"CDM"},{"code":"250","type":"RC"},{"code":"42847010630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Suboxone     Mis 12-3mg","code_information":[{"code":"CP17744631831075381","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496121203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"High-flo 26g 6mm 4 Needle--inj","code_information":[{"code":"CP17744631830083443","type":"CDM"},{"code":"250","type":"RC"},{"code":"42606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Emtriva      Cap 200mg","code_information":[{"code":"CP17744631829778906","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958060101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lodoco       Tab 0.5mg","code_information":[{"code":"CP17744631830351965","type":"CDM"},{"code":"250","type":"RC"},{"code":"82867000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Renvela      Pow 0.8gm","code_information":[{"code":"CP17744631830881309","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468013202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Renvela      Pow 2.4gm","code_information":[{"code":"CP17744631830886756","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468013102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Renvela 2.4gm Pack","code_information":[{"code":"CP17744631830889864","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468013102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Biostep      Mis 2\"x2\"","code_information":[{"code":"CP17744631828882879","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565012296","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine Sul Tab 60mg Er","code_information":[{"code":"CP17744631830501929","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858080301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Epidiolex    Sol 100mg/ml","code_information":[{"code":"CP17744631829791073","type":"CDM"},{"code":"250","type":"RC"},{"code":"70127010060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Epidiolex    Sol 100mg/ml","code_information":[{"code":"CP17744631829790928","type":"CDM"},{"code":"250","type":"RC"},{"code":"70127010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gabapent Dly Tab 300mg","code_information":[{"code":"CP17744631830011612","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382060816","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Gabapentin   Tab 300mg","code_information":[{"code":"CP17744631830013587","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382060816","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Proglycem    Sus 50mg/ml","code_information":[{"code":"CP17744631830830515","type":"CDM"},{"code":"250","type":"RC"},{"code":"57562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Proglycem Susp 50 Mg/ml 30ml","code_information":[{"code":"CP17744631830838424","type":"CDM"},{"code":"250","type":"RC"},{"code":"57562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Azithromycin Pow 1gm Pak","code_information":[{"code":"CP17744631828818971","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762305102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Pregabalin   Cap 225mg","code_information":[{"code":"CP17744631830820446","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830822466","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598029390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pregabalin-225mg-caps","code_information":[{"code":"CP17744631830821536","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Felbatol 600mg Tabs","code_information":[{"code":"CP17744631829844786","type":"CDM"},{"code":"250","type":"RC"},{"code":"37043","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Infumorph    Inj 25mg/ml","code_information":[{"code":"CP17744631830147610","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Morph/nacl 1000mg In 500ml Ns","code_information":[{"code":"CP17744631830506528","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Morph/nacl 500mg/250ml","code_information":[{"code":"CP17744631830507656","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Crinone      Gel 4% Vag","code_information":[{"code":"CP17744631829439480","type":"CDM"},{"code":"250","type":"RC"},{"code":"23615","type":"CPT","modifier":"4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["4"],"minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Tramadol Hcl Tab 25mg","code_information":[{"code":"CP17744631831168484","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888016230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Azithromycin Pow 1gm Pak","code_information":[{"code":"CP17744631828816883","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762305101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Loteprednol  Sus 0.5%","code_information":[{"code":"CP17744631830371419","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756023290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Jentadueto   Tab Xr","code_information":[{"code":"CP17744631830180671","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Jentadueto Xr 5-1000mg","code_information":[{"code":"CP17744631830189796","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tradjenta    Tab 5mg","code_information":[{"code":"CP17744631831153275","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tradjenta    Tab 5mg","code_information":[{"code":"CP17744631831159346","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tradjenta 5mg Tabs","code_information":[{"code":"CP17744631831158971","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":18,"gross_charge":18,"discounted_cash":18,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":18},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Quviviq      Tab 25mg","code_information":[{"code":"CP17744631830870387","type":"CDM"},{"code":"250","type":"RC"},{"code":"80491782503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Quviviq      Tab 50mg","code_information":[{"code":"CP17744631830879130","type":"CDM"},{"code":"250","type":"RC"},{"code":"80491785003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nicotine Pol Gum 4mg Mint","code_information":[{"code":"CP17744631830552587","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802000125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Millipred    Tab 5mg","code_information":[{"code":"CP17744631830484155","type":"CDM"},{"code":"250","type":"RC"},{"code":"23594050501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Imipenem/cilastatin 250mg","code_information":[{"code":"CP17744631830131902","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323034901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Asmanex Hfa  Aer 200 Mcg","code_information":[{"code":"CP17744631828762325","type":"CDM"},{"code":"250","type":"RC"},{"code":"85433","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830408465","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993037179","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830401268","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121148001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Phenylephrin Sol 2.5% Op","code_information":[{"code":"CP17744631830761008","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831117420","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756001540","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Hernia Trussbelt","code_information":[{"code":"CP17744631830082318","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189023280","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gemtesa      Tab 75mg","code_information":[{"code":"CP17744631830023139","type":"CDM"},{"code":"250","type":"RC"},{"code":"73336007590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Albendazole  Tab 200mg","code_information":[{"code":"CP17744631828378585","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598045202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Monistat 1   Kit 1200/2%","code_information":[{"code":"CP17744631830501922","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736044940","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ceftazidime/ Sol D5w 1gm","code_information":[{"code":"CP17744631829174763","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime/dextrose 1gm Solr","code_information":[{"code":"CP17744631829176956","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Hydroxyz Hcl Inj 50mg/ml","code_information":[{"code":"CP17744631830118951","type":"CDM"},{"code":"250","type":"RC"},{"code":"51756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Wrist Brace  Mis","code_information":[{"code":"CP17744631831381327","type":"CDM"},{"code":"250","type":"RC"},{"code":"49022075778","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Efavir/emtri Tab Tenofovi","code_information":[{"code":"CP17744631829761688","type":"CDM"},{"code":"250","type":"RC"},{"code":"93523","type":"CPT","modifier":"456"}],"standard_charges":[{"setting":"outpatient","modifier_code":["456"],"minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Efavir/emtri Tab Tenofovi","code_information":[{"code":"CP17744631829765306","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862049730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omepra/bicar Cap 20-1100","code_information":[{"code":"CP17744631830673187","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241003103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Omepra/bicar Cap 40-1100","code_information":[{"code":"CP17744631830675517","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241003203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Fondaparinux Inj 10/0.8ml","code_information":[{"code":"CP17744631829996954","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Clozaril     Tab 100mg","code_information":[{"code":"CP17744631829395189","type":"CDM"},{"code":"250","type":"RC"},{"code":"69809012705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ertapenem 500 Mg/50 Ml Ns","code_information":[{"code":"CP17744631829804349","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831042919","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sodium Chloride-0.9%-soln 10ml","code_information":[{"code":"CP17744631831040063","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Symproic     Tab 0.2mg","code_information":[{"code":"CP17744631831089264","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385004130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Timolol Gel  Sol 0.25% Op","code_information":[{"code":"CP17744631831139238","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208081825","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Dakins       Sol 0.25%","code_information":[{"code":"CP17744631829473850","type":"CDM"},{"code":"250","type":"RC"},{"code":"43609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Dakins Sol Half Str (0.25%)","code_information":[{"code":"CP17744631829478275","type":"CDM"},{"code":"250","type":"RC"},{"code":"43609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Back Brace 1 Size Adjust","code_information":[{"code":"CP17744631828829630","type":"CDM"},{"code":"250","type":"RC"},{"code":"7467667111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacosamide   Tab 200mg","code_information":[{"code":"CP17744631830200544","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877073660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Zenpep       Cap 40000","code_information":[{"code":"CP17744631831393686","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":40000,"type":"EA"}},{"description":"Zenpep       Cap 40000unt","code_information":[{"code":"CP17744631831396415","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":40000,"type":"EA"}},{"description":"Aquaphor     Oin","code_information":[{"code":"CP17744631828731616","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140003147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aquaphor Ointment","code_information":[{"code":"CP17744631828736487","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140003147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dakins       Sol 0.125%","code_information":[{"code":"CP17744631829479132","type":"CDM"},{"code":"250","type":"RC"},{"code":"43606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Dakins Sol Quarter Str","code_information":[{"code":"CP17744631829476844","type":"CDM"},{"code":"250","type":"RC"},{"code":"43606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dakins Solution 0.125%","code_information":[{"code":"CP17744631829478532","type":"CDM"},{"code":"250","type":"RC"},{"code":"43606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Deferasirox  Tab 500mg","code_information":[{"code":"CP17744631829555767","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598085430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Deferasirox  Tab 500mg","code_information":[{"code":"CP17744631829550052","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756057083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clotrimazole Loz 10mg","code_information":[{"code":"CP17744631829399209","type":"CDM"},{"code":"250","type":"RC"},{"code":"57401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clotrimazole Tro 10mg","code_information":[{"code":"CP17744631829399212","type":"CDM"},{"code":"250","type":"RC"},{"code":"57401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aricept      Tab 10mg","code_information":[{"code":"CP17744631828742009","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856024630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aricept      Tab 5mg","code_information":[{"code":"CP17744631828748171","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856024530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Belbuca      Mis 450mcg","code_information":[{"code":"CP17744631828858171","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Lexapro      Tab 20mg","code_information":[{"code":"CP17744631830328850","type":"CDM"},{"code":"250","type":"RC"},{"code":"45620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fentanyl     Dis 75mcg/hr","code_information":[{"code":"CP17744631829851526","type":"CDM"},{"code":"250","type":"RC"},{"code":"40691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Mesalamine   Sup 1000mg","code_information":[{"code":"CP17744631830431932","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714024530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Gelocast     Mis 3\"x10yd","code_information":[{"code":"CP17744631830020472","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664001052","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Huber Needle 22g X 0.5in","code_information":[{"code":"CP17744631830084936","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Huber Needle 22g X0.75","code_information":[{"code":"CP17744631830171239","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitroglyceri Oin 0.4%","code_information":[{"code":"CP17744631830569796","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830641026","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zincox 20%-nyst/triam Cream","code_information":[{"code":"CP17744631831400372","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Clonidine    Dis 0.2/24hr","code_information":[{"code":"CP17744631829373654","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862045404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ipratropium  Spr 0.03%","code_information":[{"code":"CP17744631830153016","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Diclofenac   Gel 3%","code_information":[{"code":"CP17744631829590648","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Anti-em Thg  Mis High Med","code_information":[{"code":"CP17744631828722816","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664011456","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Jobst Anti-emb X-lg N","code_information":[{"code":"CP17744631830185057","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664011462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830670707","type":"CDM"},{"code":"250","type":"RC"},{"code":"51407066305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sandimmune   Sol 100mg/ml","code_information":[{"code":"CP17744631830998478","type":"CDM"},{"code":"250","type":"RC"},{"code":"78011","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Proctozone   Cre -Hc 2.5%","code_information":[{"code":"CP17744631830837036","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629884701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Eucerin      Cre","code_information":[{"code":"CP17744631829824476","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140000021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eucerin Orig Cre Healing","code_information":[{"code":"CP17744631829822417","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140000021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alcohol Prep 70% Pads","code_information":[{"code":"CP17744631828392836","type":"CDM"},{"code":"250","type":"RC"},{"code":"67777012114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alcohol Prep Pad","code_information":[{"code":"CP17744631828393838","type":"CDM"},{"code":"250","type":"RC"},{"code":"67777012114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bath Stool Round","code_information":[{"code":"CP17744631828839770","type":"CDM"},{"code":"250","type":"RC"},{"code":"17076011118","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Contour      Kit Next Ez","code_information":[{"code":"CP17744631829410916","type":"CDM"},{"code":"250","type":"RC"},{"code":"19375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830167985","type":"CDM"},{"code":"250","type":"RC"},{"code":"37896","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stimulen     Pow","code_information":[{"code":"CP17744631831062755","type":"CDM"},{"code":"250","type":"RC"},{"code":"45713009515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stimulen Collagen Powder","code_information":[{"code":"CP17744631831065166","type":"CDM"},{"code":"250","type":"RC"},{"code":"45713009515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zubsolv      Sub 8.6-2.1","code_information":[{"code":"CP17744631831419532","type":"CDM"},{"code":"250","type":"RC"},{"code":"54123098630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":86,"type":"EA"}},{"description":"Nocdurna     Sub 27.7mcg","code_information":[{"code":"CP17744631830570778","type":"CDM"},{"code":"250","type":"RC"},{"code":"54436032530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":277,"type":"ME"}},{"description":"Tobra/dexame Sus 0.3-0.1%","code_information":[{"code":"CP17744631831143118","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238137302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830068140","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710146401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Alogliptin   Tab 12.5mg","code_information":[{"code":"CP17744631828432364","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802010365","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Haloper Dec  Inj 50mg/ml","code_information":[{"code":"CP17744631830068096","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069038101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":14,"maximum":17,"gross_charge":17,"discounted_cash":17,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":17},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Freestyle    Kit Lite","code_information":[{"code":"CP17744631830002039","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073070805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle    Mis Lite","code_information":[{"code":"CP17744631830005692","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073070805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Seroquel     Tab 300mg","code_information":[{"code":"CP17744631831000693","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Haloper Dec  Inj 500/5ml","code_information":[{"code":"CP17744631830066853","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069038401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Morphine Sul Tab 15mg","code_information":[{"code":"CP17744631830504892","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687061701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Dipentum     Cap 250mg","code_information":[{"code":"CP17744631829705821","type":"CDM"},{"code":"250","type":"RC"},{"code":"37686","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Januvia      Tab 25mg","code_information":[{"code":"CP17744631830187315","type":"CDM"},{"code":"250","type":"RC"},{"code":"60221","type":"CPT","modifier":"54"}],"standard_charges":[{"setting":"outpatient","modifier_code":["54"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Januvia      Tab 50mg","code_information":[{"code":"CP17744631830182920","type":"CDM"},{"code":"250","type":"RC"},{"code":"60112","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Januvia 25mg Tabs","code_information":[{"code":"CP17744631830184404","type":"CDM"},{"code":"250","type":"RC"},{"code":"60221","type":"CPT","modifier":"54"}],"standard_charges":[{"setting":"outpatient","modifier_code":["54"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Guaifenesin  Liq 100/5ml","code_information":[{"code":"CP17744631830068079","type":"CDM"},{"code":"250","type":"RC"},{"code":"12117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Aquacel Foam Pad 7\"x7\"","code_information":[{"code":"CP17744631828736042","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012291","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Celebrex     Cap 200mg","code_information":[{"code":"CP17744631829188033","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151008401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celebrex     Cap 200mg","code_information":[{"code":"CP17744631829189167","type":"CDM"},{"code":"250","type":"RC"},{"code":"25152","type":"CPT","modifier":"531"}],"standard_charges":[{"setting":"outpatient","modifier_code":["531"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Neo/poly/hc  Sus Op","code_information":[{"code":"CP17744631830545004","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064175","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stokn T-h Lce 15-20 Bg Ss","code_information":[{"code":"CP17744631831076955","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958859","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fondaparinux Inj 2.5/0.5","code_information":[{"code":"CP17744631829994603","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111067810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Freestyle    Kit Freedom","code_information":[{"code":"CP17744631830005581","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073070914","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 30mg Cr","code_information":[{"code":"CP17744631830712592","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011043020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycontin    Tab 30mg Er","code_information":[{"code":"CP17744631830713849","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011043020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Benicar Hct  Tab 40-12.5","code_information":[{"code":"CP17744631828859735","type":"CDM"},{"code":"250","type":"RC"},{"code":"71308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Saxagliptin  Tab 5mg","code_information":[{"code":"CP17744631830991034","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462072790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nitroglycrn  Spr 0.4mg","code_information":[{"code":"CP17744631830574822","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802021002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitroglycrn  Spr 400mcg","code_information":[{"code":"CP17744631830576573","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802021002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Aquacel Foam Pad 8\"x7\"","code_information":[{"code":"CP17744631828738066","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Back Support Xlg","code_information":[{"code":"CP17744631828821947","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189000412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Risedron Sod Tab 35mg Dr","code_information":[{"code":"CP17744631830893346","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Atomoxetine  Cap 60mg","code_information":[{"code":"CP17744631828786360","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111052230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Seroquel Xr  Tab 200mg","code_information":[{"code":"CP17744631831005232","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Niferex      Tab","code_information":[{"code":"CP17744631830561139","type":"CDM"},{"code":"250","type":"RC"},{"code":"75854032130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Colchicine   Cap 0.6mg","code_information":[{"code":"CP17744631829409697","type":"CDM"},{"code":"250","type":"RC"},{"code":"14330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Amzeeq       Aer 4%","code_information":[{"code":"CP17744631828537264","type":"CDM"},{"code":"250","type":"RC"},{"code":"72356010103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830380066","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162088003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Onglyza      Tab 2.5mg","code_information":[{"code":"CP17744631830692030","type":"CDM"},{"code":"250","type":"RC"},{"code":"31061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Onglyza      Tab 2.5mg","code_information":[{"code":"CP17744631830691993","type":"CDM"},{"code":"250","type":"RC"},{"code":"31061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Onglyza      Tab 5mg","code_information":[{"code":"CP17744631830691479","type":"CDM"},{"code":"250","type":"RC"},{"code":"31061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Onglyza 2.5mg Tabs","code_information":[{"code":"CP17744631830698684","type":"CDM"},{"code":"250","type":"RC"},{"code":"31061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Onglyza 5mg Tabs","code_information":[{"code":"CP17744631830694158","type":"CDM"},{"code":"250","type":"RC"},{"code":"31061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Optichamber  Mis Diamond","code_information":[{"code":"CP17744631830696239","type":"CDM"},{"code":"250","type":"RC"},{"code":"8373747800","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Contour Next Kit One","code_information":[{"code":"CP17744631829415829","type":"CDM"},{"code":"250","type":"RC"},{"code":"19378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lexapro      Tab 10mg","code_information":[{"code":"CP17744631830321874","type":"CDM"},{"code":"250","type":"RC"},{"code":"45620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Stock K-h Shr 20-30 Blk","code_information":[{"code":"CP17744631831065802","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958854","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Jornay Pm    Cap 60mg Er","code_information":[{"code":"CP17744631830188839","type":"CDM"},{"code":"250","type":"RC"},{"code":"71376020303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Neo-synalar  Cre","code_information":[{"code":"CP17744631830552011","type":"CDM"},{"code":"250","type":"RC"},{"code":"43538094060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zoryve       Cre 0.15%","code_information":[{"code":"CP17744631831415857","type":"CDM"},{"code":"250","type":"RC"},{"code":"80610011560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Zoryve       Cre 0.3%","code_information":[{"code":"CP17744631831414126","type":"CDM"},{"code":"250","type":"RC"},{"code":"80610013060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Zoryve       Mis 0.3%","code_information":[{"code":"CP17744631831410880","type":"CDM"},{"code":"250","type":"RC"},{"code":"80610043060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kitabis Pak  Neb 300/5ml","code_information":[{"code":"CP17744631830198926","type":"CDM"},{"code":"250","type":"RC"},{"code":"24492085056","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Omepra/bicar Pow 20-1680","code_information":[{"code":"CP17744631830671678","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241002931","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omeprazole/sod Bicarb 20/1680m","code_information":[{"code":"CP17744631830687769","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241002931","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phytonadione Inj 10mg/ml","code_information":[{"code":"CP17744631830761934","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462075825","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxaydo       Tab 7.5mg","code_information":[{"code":"CP17744631830705223","type":"CDM"},{"code":"250","type":"RC"},{"code":"69344021311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Chapstick Red Bc .15ozx1","code_information":[{"code":"CP17744631829200693","type":"CDM"},{"code":"250","type":"RC"},{"code":"57307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroquinone Cre 4%","code_information":[{"code":"CP17744631830118816","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192015101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Brinzolamide Opth 1% Susp","code_information":[{"code":"CP17744631828959927","type":"CDM"},{"code":"250","type":"RC"},{"code":"59121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Brinzolamide Sus 1%","code_information":[{"code":"CP17744631828955043","type":"CDM"},{"code":"250","type":"RC"},{"code":"59121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxycycl Hyc Inj 100mg","code_information":[{"code":"CP17744631829741723","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829743716","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382091010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Insulin Lisp Inj 100/ml","code_information":[{"code":"CP17744631830149409","type":"CDM"},{"code":"250","type":"RC"},{"code":"66733082259","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insulin Lispro Kwp 100/ml","code_information":[{"code":"CP17744631830146006","type":"CDM"},{"code":"250","type":"RC"},{"code":"66733082259","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Ipratropium  Spr 0.03%","code_information":[{"code":"CP17744631830150912","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208039830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Loteprednol  Sus 0.5%","code_information":[{"code":"CP17744631830372165","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383026505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Pancreaze    Cap 37000","code_information":[{"code":"CP17744631830736502","type":"CDM"},{"code":"250","type":"RC"},{"code":"62541040610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":37000,"type":"EA"}},{"description":"Endo Dermal  Mis 5x5 Cm","code_information":[{"code":"CP17744631829771369","type":"CDM"},{"code":"250","type":"RC"},{"code":"8567529311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gralise      Tab 900mg","code_information":[{"code":"CP17744631830059237","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427089060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Cushion Foam Flat Surface","code_information":[{"code":"CP17744631829437979","type":"CDM"},{"code":"250","type":"RC"},{"code":"9160804420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 30mg Cr","code_information":[{"code":"CP17744631830713639","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011043010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycontin    Tab 30mg Er","code_information":[{"code":"CP17744631830719779","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011043010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycontin Er 30mg Tabs","code_information":[{"code":"CP17744631830721420","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011043010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Doxycycl Hyc Inj 100mg","code_information":[{"code":"CP17744631829742034","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829740877","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline 100mg/ Ns 100ml","code_information":[{"code":"CP17744631829748339","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline 100mg/100ml Ns","code_information":[{"code":"CP17744631829743648","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Belsomra     Tab 10mg","code_information":[{"code":"CP17744631828850573","type":"CDM"},{"code":"250","type":"RC"},{"code":"60033","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Belsomra     Tab 15mg","code_information":[{"code":"CP17744631828851851","type":"CDM"},{"code":"250","type":"RC"},{"code":"60325","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Belsomra     Tab 20mg","code_information":[{"code":"CP17744631828857869","type":"CDM"},{"code":"250","type":"RC"},{"code":"60335","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Belsomra     Tab 5mg","code_information":[{"code":"CP17744631828857611","type":"CDM"},{"code":"250","type":"RC"},{"code":"60005","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Belsomra 5mg Tabs","code_information":[{"code":"CP17744631828857355","type":"CDM"},{"code":"250","type":"RC"},{"code":"60005","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Maxidex      Sus 0.1% Op","code_information":[{"code":"CP17744631830406466","type":"CDM"},{"code":"250","type":"RC"},{"code":"99806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Spr 20mg/act","code_information":[{"code":"CP17744631831082021","type":"CDM"},{"code":"250","type":"RC"},{"code":"52718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ketorolac    Sol 0.5%","code_information":[{"code":"CP17744631830191024","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314012605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Azelastine   Spr 0.1%","code_information":[{"code":"CP17744631828802441","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Spr 0.1%","code_information":[{"code":"CP17744631828800768","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505083305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine Spr 0.1% (200 Dose)","code_information":[{"code":"CP17744631828807502","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505083305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine Spr 0.1% 200 Spr","code_information":[{"code":"CP17744631828806235","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Premarin Vag Cre 0.625mg","code_information":[{"code":"CP17744631830820194","type":"CDM"},{"code":"250","type":"RC"},{"code":"46087","type":"CPT","modifier":"221"}],"standard_charges":[{"setting":"outpatient","modifier_code":["221"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Diazepam     Inj 5mg/ml","code_information":[{"code":"CP17744631829585486","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Methylpr Ace Inj 400/5ml","code_information":[{"code":"CP17744631830453661","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021082105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Blood Press  Kit Monitor","code_information":[{"code":"CP17744631828931493","type":"CDM"},{"code":"250","type":"RC"},{"code":"73796000018","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Jobst Mens Drss Brn Xl 1","code_information":[{"code":"CP17744631830180910","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566410791","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Jobst Sock Men Lge Blk","code_information":[{"code":"CP17744631830184200","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566410782","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Jobst Soft Knee 8-15 Rib","code_information":[{"code":"CP17744631830184700","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566400760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"True Metrix  Kit Air","code_information":[{"code":"CP17744631831194062","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151149002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zyprexa      Tab 5mg","code_information":[{"code":"CP17744631831416476","type":"CDM"},{"code":"250","type":"RC"},{"code":"24115","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Omepra/bicar Cap 40-1100","code_information":[{"code":"CP17744631830672824","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111036430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Omepra/bicar Pow 20-1680","code_information":[{"code":"CP17744631830678326","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682099030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omepra/bicar Pow 20-1680","code_information":[{"code":"CP17744631830674871","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380018202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omepra/bicar Pow 40-1680","code_information":[{"code":"CP17744631830671561","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241003031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omepra/bicar Pow 40-1680","code_information":[{"code":"CP17744631830670668","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682099130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloper Dec  Inj 50mg/ml","code_information":[{"code":"CP17744631830060199","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021083101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Daliresp     Tab 500mcg","code_information":[{"code":"CP17744631829476136","type":"CDM"},{"code":"250","type":"RC"},{"code":"31000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Daliresp     Tab 500mcg","code_information":[{"code":"CP17744631829476741","type":"CDM"},{"code":"250","type":"RC"},{"code":"31000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Daliresp     Tab 250mcg","code_information":[{"code":"CP17744631829470183","type":"CDM"},{"code":"250","type":"RC"},{"code":"31000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Daliresp     Tab 250mcg","code_information":[{"code":"CP17744631829477389","type":"CDM"},{"code":"250","type":"RC"},{"code":"31000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Invalid Cush Mis Foam","code_information":[{"code":"CP17744631830154696","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601087010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Benefiber On Pow The Go","code_information":[{"code":"CP17744631828851869","type":"CDM"},{"code":"250","type":"RC"},{"code":"86790016280","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comp Stock Xl 15-20mmhg","code_information":[{"code":"CP17744631829414215","type":"CDM"},{"code":"250","type":"RC"},{"code":"73348","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wall Bar     Mis Text/24\"","code_information":[{"code":"CP17744631831302240","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601012120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zoloft       Tab 100mg","code_information":[{"code":"CP17744631831403671","type":"CDM"},{"code":"250","type":"RC"},{"code":"49491","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Zoloft       Tab 50mg","code_information":[{"code":"CP17744631831400849","type":"CDM"},{"code":"250","type":"RC"},{"code":"49490","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Zoloft 25mg Tabs","code_information":[{"code":"CP17744631831406303","type":"CDM"},{"code":"250","type":"RC"},{"code":"49496","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nucynta      Tab 75mg","code_information":[{"code":"CP17744631830643174","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510007510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Azelastine   Dro 0.05%","code_information":[{"code":"CP17744631828803305","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332050606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Dro 0.05%","code_information":[{"code":"CP17744631828806070","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314030802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Efavirenz    Tab 600mg","code_information":[{"code":"CP17744631829760322","type":"CDM"},{"code":"250","type":"RC"},{"code":"37822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Post-op Shoe Women Lg","code_information":[{"code":"CP17744631830790498","type":"CDM"},{"code":"250","type":"RC"},{"code":"70878000104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Endometrin   Sup 100mg","code_information":[{"code":"CP17744631829779330","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566650003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Maraviroc    Tab 150mg","code_information":[{"code":"CP17744631830400842","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722057960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Nebulizer    Mis Cup/tubi","code_information":[{"code":"CP17744631830540941","type":"CDM"},{"code":"250","type":"RC"},{"code":"50486008249","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Regenecare   Gel Ha 2%","code_information":[{"code":"CP17744631830889985","type":"CDM"},{"code":"250","type":"RC"},{"code":"66977010703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Regenecare-a+d-desitin Oint","code_information":[{"code":"CP17744631830887715","type":"CDM"},{"code":"250","type":"RC"},{"code":"66977010703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prilosec     Pow 10mg","code_information":[{"code":"CP17744631830832161","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515061001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prilosec 10mg Powder Packet","code_information":[{"code":"CP17744631830834782","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515061001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ala-scalp    Lot 2%","code_information":[{"code":"CP17744631828377714","type":"CDM"},{"code":"250","type":"RC"},{"code":"77052001001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Brimonidine  Sol 0.15%","code_information":[{"code":"CP17744631828959783","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314014410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Vortex Valve Mis Chamber","code_information":[{"code":"CP17744631831306617","type":"CDM"},{"code":"250","type":"RC"},{"code":"83490051035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":13,"maximum":16,"gross_charge":16,"discounted_cash":16,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":16},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluoromethol Sus 0.1% Op","code_information":[{"code":"CP17744631829977551","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758088010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Namenda Xr   Cap 28mg","code_information":[{"code":"CP17744631830537274","type":"CDM"},{"code":"250","type":"RC"},{"code":"45634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Namenda Xr   Cap 7mg","code_information":[{"code":"CP17744631830534767","type":"CDM"},{"code":"250","type":"RC"},{"code":"45634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Nicotine Pol Gum 2mg","code_information":[{"code":"CP17744631830558961","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830403617","type":"CDM"},{"code":"250","type":"RC"},{"code":"70368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Eucerin Itch Lot 0.1%","code_information":[{"code":"CP17744631829828238","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140002657","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Millipred    Tab 5mg","code_information":[{"code":"CP17744631830489301","type":"CDM"},{"code":"250","type":"RC"},{"code":"73534050501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Naloxone 2mg/2ml Inj","code_information":[{"code":"CP17744631830535643","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Strattera    Cap 100mg","code_information":[{"code":"CP17744631831073958","type":"CDM"},{"code":"250","type":"RC"},{"code":"23251","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Vitamin D3   Pow","code_information":[{"code":"CP17744631831295970","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779220806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Erythromycin Tab 500mg Bs","code_information":[{"code":"CP17744631829819676","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536010503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lexapro      Tab 5mg","code_information":[{"code":"CP17744631830322746","type":"CDM"},{"code":"250","type":"RC"},{"code":"45620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mepilex Ag 4 X 4","code_information":[{"code":"CP17744631830429777","type":"CDM"},{"code":"250","type":"RC"},{"code":"73243061204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prednisolone Tab 5mg","code_information":[{"code":"CP17744631830818255","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135043730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Epinastine   Dro 0.05%","code_information":[{"code":"CP17744631829792293","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adult Crutch Mis Forearm","code_information":[{"code":"CP17744631828355295","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703000540","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Myrbetriq    Tab 25mg","code_information":[{"code":"CP17744631830531937","type":"CDM"},{"code":"250","type":"RC"},{"code":"46926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Myrbetriq    Tab 25mg","code_information":[{"code":"CP17744631830530951","type":"CDM"},{"code":"250","type":"RC"},{"code":"46926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amlod/valsar Tab /Hctz","code_information":[{"code":"CP17744631828489381","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380019801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/valsar/hctz Tab 5-160-25","code_information":[{"code":"CP17744631828487627","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380019801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Aml-val-hctz  5/160/25mg Tab","code_information":[{"code":"CP17744631828499845","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380019801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gamunex-c    Inj 5gm/50ml","code_information":[{"code":"CP17744631830021707","type":"CDM"},{"code":"250","type":"RC"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Clozapine     Tab 150/odt","code_information":[{"code":"CP17744631829394669","type":"CDM"},{"code":"250","type":"RC"},{"code":"93537","type":"CPT","modifier":"684"}],"standard_charges":[{"setting":"outpatient","modifier_code":["684"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Clozapine    Tab 150/odt","code_information":[{"code":"CP17744631829397142","type":"CDM"},{"code":"250","type":"RC"},{"code":"93537","type":"CPT","modifier":"684"}],"standard_charges":[{"setting":"outpatient","modifier_code":["684"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Savaysa      Tab 60mg","code_information":[{"code":"CP17744631830990071","type":"CDM"},{"code":"250","type":"RC"},{"code":"65597020330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Savaysa 30mg Tabs","code_information":[{"code":"CP17744631830998235","type":"CDM"},{"code":"250","type":"RC"},{"code":"65597020230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Contour Next Mis One","code_information":[{"code":"CP17744631829412629","type":"CDM"},{"code":"250","type":"RC"},{"code":"19378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vanco 550mg/100ml Ns","code_information":[{"code":"CP17744631831233982","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Vanco 750mgns 250ml Vm","code_information":[{"code":"CP17744631831234157","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vanco 750mg / 250 Ml Ns Kit","code_information":[{"code":"CP17744631831230032","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vanco 750mg/250 Sod Cl 0.9%","code_information":[{"code":"CP17744631831234619","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin   Inj 750mg","code_information":[{"code":"CP17744631831235329","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 1.5gm/500 Ml Ns Kt","code_information":[{"code":"CP17744631831238915","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 750 Mg/250 Ml Ns Kt","code_information":[{"code":"CP17744631831248662","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750mg/250 Ml Ns","code_information":[{"code":"CP17744631831242934","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750mg/250ml Ns","code_information":[{"code":"CP17744631831240915","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin600mg/ns250ml","code_information":[{"code":"CP17744631831247512","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Movantik     Tab 12.5mg","code_information":[{"code":"CP17744631830515435","type":"CDM"},{"code":"250","type":"RC"},{"code":"82625880101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ultravate    Lot 0.05%","code_information":[{"code":"CP17744631831209152","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631012251","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ultravate    Lot 0.05%","code_information":[{"code":"CP17744631831206457","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631012204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Iv Nexiva Canulla 24g .75","code_information":[{"code":"CP17744631830179098","type":"CDM"},{"code":"250","type":"RC"},{"code":"38353","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Verkazia     Emu 0.1% Op","code_information":[{"code":"CP17744631831268451","type":"CDM"},{"code":"250","type":"RC"},{"code":"65086000112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Citalopram   Cap 30mg","code_information":[{"code":"CP17744631829249385","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427069130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Imatinib Mes Tab 100mg","code_information":[{"code":"CP17744631830130831","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tamiflu      Cap 75mg","code_information":[{"code":"CP17744631831108446","type":"CDM"},{"code":"250","type":"RC"},{"code":"40800","type":"CPT","modifier":"85"}],"standard_charges":[{"setting":"outpatient","modifier_code":["85"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Imatinib Mes Tab 100mg","code_information":[{"code":"CP17744631830130884","type":"CDM"},{"code":"250","type":"RC"},{"code":"93762","type":"CPT","modifier":"998"}],"standard_charges":[{"setting":"outpatient","modifier_code":["998"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Imatinib Mes Tab 100mg","code_information":[{"code":"CP17744631830137707","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651024090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Acetylcyst   Sol 20%","code_information":[{"code":"CP17744631828307287","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Acetylcysteine 10% Ophth Drop","code_information":[{"code":"CP17744631828302664","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 20% Soln Vial","code_information":[{"code":"CP17744631828317338","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Heating Pad Moist/dry Reg","code_information":[{"code":"CP17744631830077340","type":"CDM"},{"code":"250","type":"RC"},{"code":"38056089720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Imatinib Mes Tab 100mg","code_information":[{"code":"CP17744631830139152","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485020290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Zemplar      Inj 5mcg/ml","code_information":[{"code":"CP17744631831394391","type":"CDM"},{"code":"250","type":"RC"},{"code":"74165","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nebulizer Compressor","code_information":[{"code":"CP17744631830547297","type":"CDM"},{"code":"250","type":"RC"},{"code":"89076034911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Droxidopa    Cap 300mg","code_information":[{"code":"CP17744631829755837","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241020190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Droxidopa    Cap 300mg","code_information":[{"code":"CP17744631829754145","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710139109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830065996","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069038310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Futuro Wrist Mis Support","code_information":[{"code":"CP17744631830015627","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020158","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumat-naprox Tab 85-500mg","code_information":[{"code":"CP17744631831074812","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":85,"type":"ME"}},{"description":"Acetylcyst   Sol 10%","code_information":[{"code":"CP17744631828262371","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 10% Soln Vial","code_information":[{"code":"CP17744631828305560","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Biopatch Antimicrobial Pr","code_information":[{"code":"CP17744631828882367","type":"CDM"},{"code":"250","type":"RC"},{"code":"70265900000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breast Surgical Wrap","code_information":[{"code":"CP17744631828944916","type":"CDM"},{"code":"250","type":"RC"},{"code":"36992600000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Buprenorphin Dis 5mcg/hr","code_information":[{"code":"CP17744631828983192","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238120202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ceftriax/dex Inj 2gm","code_information":[{"code":"CP17744631829175893","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2gm/50ml Dex","code_information":[{"code":"CP17744631829185492","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone/d5 2gm/50 Ml","code_information":[{"code":"CP17744631829184600","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone/dex Inj 2gm","code_information":[{"code":"CP17744631829183032","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Lid Scrub    Kit Complian","code_information":[{"code":"CP17744631830322248","type":"CDM"},{"code":"250","type":"RC"},{"code":"15718010340","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Loteprednol  Gel 0.5% Op","code_information":[{"code":"CP17744631830370837","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485063005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydroco/apap Tab 10-300mg","code_information":[{"code":"CP17744631830090628","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702019401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830768357","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682017030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Januvia      Tab 100mg","code_information":[{"code":"CP17744631830186379","type":"CDM"},{"code":"250","type":"RC"},{"code":"60277","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830676045","type":"CDM"},{"code":"250","type":"RC"},{"code":"58602000640","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Aer Hfa","code_information":[{"code":"CP17744631828377175","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097014260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Hfa 90 Mcg 200 Inh","code_information":[{"code":"CP17744631828392492","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097014260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Protonix     Tab 20mg","code_information":[{"code":"CP17744631830856665","type":"CDM"},{"code":"250","type":"RC"},{"code":"80843","type":"CPT","modifier":"81"}],"standard_charges":[{"setting":"outpatient","modifier_code":["81"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Protonix     Tab 40mg","code_information":[{"code":"CP17744631830854261","type":"CDM"},{"code":"250","type":"RC"},{"code":"80841","type":"CPT","modifier":"81"}],"standard_charges":[{"setting":"outpatient","modifier_code":["81"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Loreev Xr    Cap 1mg","code_information":[{"code":"CP17744631830361132","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427065830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Loreev Xr    Cap 2mg","code_information":[{"code":"CP17744631830365876","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427066330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Concerta     Tab 54mg","code_information":[{"code":"CP17744631829413972","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":54,"type":"ME"}},{"description":"Protonix     Pak","code_information":[{"code":"CP17744631830853917","type":"CDM"},{"code":"250","type":"RC"},{"code":"80844","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Protonix     Pak","code_information":[{"code":"CP17744631830852651","type":"CDM"},{"code":"250","type":"RC"},{"code":"80844","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Protonix     Pak 40mg","code_information":[{"code":"CP17744631830852807","type":"CDM"},{"code":"250","type":"RC"},{"code":"80844","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sorilux      Aer 0.005%","code_information":[{"code":"CP17744631831052937","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862037612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Humidifier   Mis 1.25 Gal","code_information":[{"code":"CP17744631830087327","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703000661","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pexeva       Tab 20mg","code_information":[{"code":"CP17744631830751064","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766020201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Bromfenac    Dro 0.075%","code_information":[{"code":"CP17744631828950804","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180043401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Collagen Dressing-silver","code_information":[{"code":"CP17744631829406832","type":"CDM"},{"code":"250","type":"RC"},{"code":"16186","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Inspra       Tab 25mg","code_information":[{"code":"CP17744631830143638","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151014293","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"True Metrix  Kit Meter","code_information":[{"code":"CP17744631831194768","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151147002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol    Dis 0.1mg","code_information":[{"code":"CP17744631829824328","type":"CDM"},{"code":"250","type":"RC"},{"code":"37833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830064379","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069038301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Haloperidol 100mg/ml Soln","code_information":[{"code":"CP17744631830079438","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069038301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hydro Sod Su Inj 100mg","code_information":[{"code":"CP17744631830091034","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097000467","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tretinoin    Cap 10mg","code_information":[{"code":"CP17744631831177183","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370026801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Asmanex Hfa  Aer 100 Mcg","code_information":[{"code":"CP17744631828767452","type":"CDM"},{"code":"250","type":"RC"},{"code":"85433","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Neurontin    Tab 600mg","code_information":[{"code":"CP17744631830554317","type":"CDM"},{"code":"250","type":"RC"},{"code":"71051","type":"CPT","modifier":"324"}],"standard_charges":[{"setting":"outpatient","modifier_code":["324"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Fluoromethol Sus 0.1% Op","code_information":[{"code":"CP17744631829972567","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxycycl Hyc Inj 100mg","code_information":[{"code":"CP17744631829745422","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829742009","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830531015","type":"CDM"},{"code":"250","type":"RC"},{"code":"40917","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Disulfiram   Tab 500mg","code_information":[{"code":"CP17744631829715695","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135043230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Buprenorphin Dis 10mcg/hr","code_information":[{"code":"CP17744631828974190","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858049340","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cipro/dexa   Sus 0.3-0.1%","code_information":[{"code":"CP17744631829234280","type":"CDM"},{"code":"250","type":"RC"},{"code":"78161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Sevelam Hcl  Tab 800mg","code_information":[{"code":"CP17744631831003658","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603014801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831017084","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603014801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Pandel       Cre 0.1%","code_information":[{"code":"CP17744631830734543","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559032580","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pandel       Cre 0.1%","code_information":[{"code":"CP17744631830734937","type":"CDM"},{"code":"250","type":"RC"},{"code":"10337015380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pristiq      Tab 100mg","code_information":[{"code":"CP17744631830837797","type":"CDM"},{"code":"250","type":"RC"},{"code":"81222","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pristiq      Tab 25mg","code_information":[{"code":"CP17744631830832137","type":"CDM"},{"code":"250","type":"RC"},{"code":"81210","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Prozac       Cap 20mg","code_information":[{"code":"CP17744631830853582","type":"CDM"},{"code":"250","type":"RC"},{"code":"77731","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828136731","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679002101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828130760","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598035804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828131538","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828140540","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291002412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831051487","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zetia        Tab 10mg","code_information":[{"code":"CP17744631831396622","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206017801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828131775","type":"CDM"},{"code":"250","type":"RC"},{"code":"82293000110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828140432","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828149079","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205003092","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ampi-sulb 3gm/100ml Ns 0.9 Mb+","code_information":[{"code":"CP17744631828534971","type":"CDM"},{"code":"250","type":"RC"},{"code":"49001","type":"CPT","modifier":"483"}],"standard_charges":[{"setting":"outpatient","modifier_code":["483"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Unasyn       Inj 3gm","code_information":[{"code":"CP17744631831200844","type":"CDM"},{"code":"250","type":"RC"},{"code":"49001","type":"CPT","modifier":"483"}],"standard_charges":[{"setting":"outpatient","modifier_code":["483"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Unasyn 3 Gm/100 Ml Ns Pb+","code_information":[{"code":"CP17744631831207856","type":"CDM"},{"code":"250","type":"RC"},{"code":"49001","type":"CPT","modifier":"483"}],"standard_charges":[{"setting":"outpatient","modifier_code":["483"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Abdominal Binder","code_information":[{"code":"CP17744631828106145","type":"CDM"},{"code":"250","type":"RC"},{"code":"28470","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pepcid       Tab 20mg","code_information":[{"code":"CP17744631830742279","type":"CDM"},{"code":"250","type":"RC"},{"code":"18744","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828945245","type":"CDM"},{"code":"250","type":"RC"},{"code":"59124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830400995","type":"CDM"},{"code":"250","type":"RC"},{"code":"70368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12,"maximum":15,"gross_charge":15,"discounted_cash":15,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":15},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cane-quad Base","code_information":[{"code":"CP17744631829103333","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703012850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chlorzoxazon Tab 250mg","code_information":[{"code":"CP17744631829224339","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980058206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Onexton      Gel 1.2-3.75","code_information":[{"code":"CP17744631830691317","type":"CDM"},{"code":"250","type":"RC"},{"code":"18730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Oxycodone    Tab 10mg","code_information":[{"code":"CP17744631830713074","type":"CDM"},{"code":"250","type":"RC"},{"code":"71335142204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Desmopressin Inj 4mcg/ml","code_information":[{"code":"CP17744631829566462","type":"CDM"},{"code":"250","type":"RC"},{"code":"83634045101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fentanyl     Dis 12mcg/hr","code_information":[{"code":"CP17744631829857490","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042347","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Nexletol     Tab 180mg","code_information":[{"code":"CP17744631830554012","type":"CDM"},{"code":"250","type":"RC"},{"code":"72426011803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828130249","type":"CDM"},{"code":"250","type":"RC"},{"code":"72606056601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Allopurinol  Tab 200mg","code_information":[{"code":"CP17744631828429655","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571088409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Biopatch Protective Disk","code_information":[{"code":"CP17744631828880287","type":"CDM"},{"code":"250","type":"RC"},{"code":"70503100523","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Kit Start 49","code_information":[{"code":"CP17744631830219719","type":"CDM"},{"code":"250","type":"RC"},{"code":"69102013710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxercalcif  Cap 1mcg","code_information":[{"code":"CP17744631829731690","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155053925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nystatin/zinc/triple_abx","code_information":[{"code":"CP17744631830654482","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystop       Pow 100000","code_information":[{"code":"CP17744631830653517","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystop 100000iu Powder","code_information":[{"code":"CP17744631830653672","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":100000,"type":"F2"}},{"description":"Deferasirox  Gra 180mg","code_information":[{"code":"CP17744631829543850","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097056053","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Rocaltrol    Sol 1mcg/ml","code_information":[{"code":"CP17744631830910916","type":"CDM"},{"code":"250","type":"RC"},{"code":"30698091115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Travoprost   Dro 0.004%","code_information":[{"code":"CP17744631831163921","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571013027","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo-polycin  Oin Hc 1%op","code_information":[{"code":"CP17744631830544319","type":"CDM"},{"code":"250","type":"RC"},{"code":"57441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 12mcg/hr","code_information":[{"code":"CP17744631829854421","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828796189","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478021502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830065398","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710146301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Latanoprost  Sol 0.005%","code_information":[{"code":"CP17744631830223318","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069042101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Imipenem/cil Inj 250mg","code_information":[{"code":"CP17744631830134757","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323034925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Pill Count+spt","code_information":[{"code":"CP17744631830777094","type":"CDM"},{"code":"250","type":"RC"},{"code":"2571523087","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prozac       Cap 10mg","code_information":[{"code":"CP17744631830855369","type":"CDM"},{"code":"250","type":"RC"},{"code":"77731","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mueller Adj  Mis Back","code_information":[{"code":"CP17744631830517668","type":"CDM"},{"code":"250","type":"RC"},{"code":"74676067111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tetracycline Cap 250mg","code_information":[{"code":"CP17744631831124655","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Nystatin     Cre 100000","code_information":[{"code":"CP17744631830641547","type":"CDM"},{"code":"250","type":"RC"},{"code":"31602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Disulfiram   Tab 500mg","code_information":[{"code":"CP17744631829711378","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794002908","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Prednisone   Sol 5mg/5ml","code_information":[{"code":"CP17744631830816692","type":"CDM"},{"code":"250","type":"RC"},{"code":"54372","type":"CPT","modifier":"250"}],"standard_charges":[{"setting":"outpatient","modifier_code":["250"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ammonium Lac Lot 12%","code_information":[{"code":"CP17744631828498913","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802041954","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Ammonium Lactate 12% Lotn (R)","code_information":[{"code":"CP17744631828490058","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802041954","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Betameth Dip Cre 0.05%","code_information":[{"code":"CP17744631828861486","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714099602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Betamethasone Dipro 0.05% Crea","code_information":[{"code":"CP17744631828875719","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714099602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Medi-honey 4\"x5\" Pads","code_information":[{"code":"CP17744631830402278","type":"CDM"},{"code":"250","type":"RC"},{"code":"70299000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sandostatin  Inj 50mcg/ml","code_information":[{"code":"CP17744631830991455","type":"CDM"},{"code":"250","type":"RC"},{"code":"78018","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830069132","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603023001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Keppra       Tab 750mg","code_information":[{"code":"CP17744631830183496","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474059640","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828136729","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714096301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828146236","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603011001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Brimonidine  Gel 0.33%","code_information":[{"code":"CP17744631828946673","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802007830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":33,"type":"EA"}},{"description":"Hc 1% Rectal Cream","code_information":[{"code":"CP17744631830079466","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort    Cre 1%","code_information":[{"code":"CP17744631830100484","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lipitor      Tab 10mg","code_information":[{"code":"CP17744631830348473","type":"CDM"},{"code":"250","type":"RC"},{"code":"71015","type":"CPT","modifier":"523"}],"standard_charges":[{"setting":"outpatient","modifier_code":["523"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nys/lido/zinc/hc","code_information":[{"code":"CP17744631830645527","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nyst1%/hyd1/zno20/pet/a&d","code_information":[{"code":"CP17744631830649629","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/ssd1%/hydct1%/zno40%","code_information":[{"code":"CP17744631830643633","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticasone  Spr 50mcg","code_information":[{"code":"CP17744631829982044","type":"CDM"},{"code":"250","type":"RC"},{"code":"54327","type":"CPT","modifier":"99"}],"standard_charges":[{"setting":"outpatient","modifier_code":["99"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluticasone 50mcg Spray","code_information":[{"code":"CP17744631829980666","type":"CDM"},{"code":"250","type":"RC"},{"code":"54327","type":"CPT","modifier":"99"}],"standard_charges":[{"setting":"outpatient","modifier_code":["99"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Haloper Dec  Inj 50mg/ml","code_information":[{"code":"CP17744631830065337","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061581","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830409938","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150032901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Nucynta Er   Tab 50mg","code_information":[{"code":"CP17744631830640797","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510005860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cefazolin    Inj 2gm","code_information":[{"code":"CP17744631829145502","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2 Gm/100 Ml D5w","code_information":[{"code":"CP17744631829158978","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2 Gm/100 Ml Ns Mb+","code_information":[{"code":"CP17744631829151417","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2 Gm/50 Ml Ns Mb+","code_information":[{"code":"CP17744631829152870","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm In 100ml Ns","code_information":[{"code":"CP17744631829159090","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Mb+","code_information":[{"code":"CP17744631829156196","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Ns","code_information":[{"code":"CP17744631829150826","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Nsmb+ Kt","code_information":[{"code":"CP17744631829155239","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/50ml D5w Vm","code_information":[{"code":"CP17744631829153407","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/50ml Ns Mb+","code_information":[{"code":"CP17744631829150119","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 3 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829158396","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefazolin3gm/100mlns","code_information":[{"code":"CP17744631829150206","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefazolin6g/250ml Ns","code_information":[{"code":"CP17744631829151309","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":6,"type":"GR"}},{"description":"Plaquenil    Tab 200mg","code_information":[{"code":"CP17744631830788942","type":"CDM"},{"code":"250","type":"RC"},{"code":"59212056210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tamiflu      Cap 30mg","code_information":[{"code":"CP17744631831103030","type":"CDM"},{"code":"250","type":"RC"},{"code":"40802","type":"CPT","modifier":"85"}],"standard_charges":[{"setting":"outpatient","modifier_code":["85"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830061468","type":"CDM"},{"code":"250","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cefixime     Cap 400mg","code_information":[{"code":"CP17744631829176174","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180042308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Footrest Wheelchair","code_information":[{"code":"CP17744631829996969","type":"CDM"},{"code":"250","type":"RC"},{"code":"76582","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nizoral A-d  Sha 1%","code_information":[{"code":"CP17744631830570726","type":"CDM"},{"code":"250","type":"RC"},{"code":"55505019140","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830699036","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180067711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Hysingla Er  Tab 20 Mg","code_information":[{"code":"CP17744631830122904","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011027160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Methylpr Ace Inj 80mg/ml","code_information":[{"code":"CP17744631830456468","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Prevacid     Cap 30mg Dr","code_information":[{"code":"CP17744631830824229","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764004613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Prevacid     Tab 15mg Stb","code_information":[{"code":"CP17744631830822139","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764054311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Prevacid     Tab 30mg Stb","code_information":[{"code":"CP17744631830825561","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764054411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828137635","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505432701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Fentanyl     Dis 12mcg/hr","code_information":[{"code":"CP17744631829851336","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Fentanyl 12mcg/hr","code_information":[{"code":"CP17744631829857457","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829232997","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714008001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Maxidex      Sus 0.1% Op","code_information":[{"code":"CP17744631830405034","type":"CDM"},{"code":"250","type":"RC"},{"code":"78092","type":"CPT","modifier":"525"}],"standard_charges":[{"setting":"outpatient","modifier_code":["525"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829231331","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877050530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829233410","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722010530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829231270","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829238719","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862083330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829236017","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380088504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Cinacalcet   Tab 90mg","code_information":[{"code":"CP17744631829232699","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335060083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830535281","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Abiraterone  Tab 250mg","code_information":[{"code":"CP17744631828146420","type":"CDM"},{"code":"250","type":"RC"},{"code":"71921017820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Heparin Sod  Inj 10000/ml","code_information":[{"code":"CP17744631830074553","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Reversible   Mis Wrist Br","code_information":[{"code":"CP17744631830899603","type":"CDM"},{"code":"250","type":"RC"},{"code":"74676067231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcium Silver Dress 1x12","code_information":[{"code":"CP17744631829080470","type":"CDM"},{"code":"250","type":"RC"},{"code":"98169","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830153760","type":"CDM"},{"code":"250","type":"RC"},{"code":"37896","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830427990","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436005504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Detrol La    Cap 4mg","code_information":[{"code":"CP17744631829575273","type":"CDM"},{"code":"250","type":"RC"},{"code":"95191","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Methylpr Ss  Inj 1000mg","code_information":[{"code":"CP17744631830455289","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323026530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Sulfadiazine Tab 500mg","code_information":[{"code":"CP17744631831077634","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806075760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lamivudine   Tab 100mg","code_information":[{"code":"CP17744631830219026","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505325006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamivudine 100mg Tabs","code_information":[{"code":"CP17744631830217974","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505325006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phytonadione Inj 1mg/0.5","code_information":[{"code":"CP17744631830761050","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097070996","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Phytonadione Suv 1mg/0.5 Dose","code_information":[{"code":"CP17744631830766889","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097070996","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bacitracin Oint / Ssd Cre 1%","code_information":[{"code":"CP17744631828821404","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mirabegron   Tab 50mg Er","code_information":[{"code":"CP17744631830495838","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Njzinc Oxide 20%/ssd 1%","code_information":[{"code":"CP17744631830572658","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830765711","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238105103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Silverdene/criticaid","code_information":[{"code":"CP17744631831028227","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ssd          Cre 1%","code_information":[{"code":"CP17744631831064716","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ssd/lidocaine5%/vaseline","code_information":[{"code":"CP17744631831060859","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ssd/miconaz/triacinolon Cre","code_information":[{"code":"CP17744631831068166","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ssd/triacinolon Cre","code_information":[{"code":"CP17744631831069929","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Toilet Seat  Mis Raised","code_information":[{"code":"CP17744631831142989","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601065110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide 40/ Silvadene Cream","code_information":[{"code":"CP17744631831403168","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Asmanex Hfa  Aer 50mcg","code_information":[{"code":"CP17744631828761033","type":"CDM"},{"code":"250","type":"RC"},{"code":"85222","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Concerta     Tab 36mg","code_information":[{"code":"CP17744631829415119","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":36,"type":"ME"}},{"description":"Albuterol    Aer Hfa","code_information":[{"code":"CP17744631828372000","type":"CDM"},{"code":"250","type":"RC"},{"code":"54074","type":"CPT","modifier":"287"}],"standard_charges":[{"setting":"outpatient","modifier_code":["287"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Hfa 90 Mcg 200 Inh","code_information":[{"code":"CP17744631828396976","type":"CDM"},{"code":"250","type":"RC"},{"code":"54074","type":"CPT","modifier":"287"}],"standard_charges":[{"setting":"outpatient","modifier_code":["287"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Albuterol Sulfate Hfa 200 Puff","code_information":[{"code":"CP17744631828391942","type":"CDM"},{"code":"250","type":"RC"},{"code":"54074","type":"CPT","modifier":"287"}],"standard_charges":[{"setting":"outpatient","modifier_code":["287"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nesina       Tab 25mg","code_information":[{"code":"CP17744631830558826","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764025030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Oseni 25/15mg Tabs","code_information":[{"code":"CP17744631830693351","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764025103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Blood Pressu Kit Cuff/lg","code_information":[{"code":"CP17744631828933720","type":"CDM"},{"code":"250","type":"RC"},{"code":"73796080034","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Gel  Sol 0.5% Op","code_information":[{"code":"CP17744631831139686","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208081905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Nicotrol Ns  Spr 10mg/ml","code_information":[{"code":"CP17744631830567448","type":"CDM"},{"code":"250","type":"RC"},{"code":"95401","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ofloxacin    Tab 300mg","code_information":[{"code":"CP17744631830667093","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834020050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Hydromorphon Tab 4mg","code_information":[{"code":"CP17744631830117814","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687059001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Enoxaparin   Inj 150mg/ml","code_information":[{"code":"CP17744631829781550","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fulvestrant  Inj 250/5ml","code_information":[{"code":"CP17744631830000779","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121146302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Nitroglycrn  Spr 0.4mg","code_information":[{"code":"CP17744631830575883","type":"CDM"},{"code":"250","type":"RC"},{"code":"70003030020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":11,"maximum":14,"gross_charge":14,"discounted_cash":14,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":14},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Flucytosine  Cap 250mg","code_information":[{"code":"CP17744631829960417","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651033101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Micafungin 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830473641","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023022910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Valproic Acd Sol 250/5ml","code_information":[{"code":"CP17744631831220131","type":"CDM"},{"code":"250","type":"RC"},{"code":"12146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Stocking K-h 20-30 L","code_information":[{"code":"CP17744631831060272","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking T-h Xl 20-30","code_information":[{"code":"CP17744631831076902","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960219","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valtrex      Tab 500mg","code_information":[{"code":"CP17744631831228010","type":"CDM"},{"code":"250","type":"RC"},{"code":"17309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Brimonidine  Sol 0.1% Op","code_information":[{"code":"CP17744631828954306","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Aspa Inj 70/30","code_information":[{"code":"CP17744631830143790","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Insulin Aspart 70/30","code_information":[{"code":"CP17744631830146048","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Aspart 70/30 Mdv 10ml","code_information":[{"code":"CP17744631830142518","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Insulin Aspart 70/30 Vial","code_information":[{"code":"CP17744631830141309","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070020011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Erythrom Eth Tab 400mg","code_information":[{"code":"CP17744631829803914","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338011003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830067290","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021083301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamictal Odt Tab 25mg","code_information":[{"code":"CP17744631830204640","type":"CDM"},{"code":"250","type":"RC"},{"code":"17307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nucynta      Tab 50mg","code_information":[{"code":"CP17744631830640270","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510005010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Allevyn Sacral 8-1/2x9","code_information":[{"code":"CP17744631828411254","type":"CDM"},{"code":"250","type":"RC"},{"code":"83995","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zyprexa      Tab 2.5mg","code_information":[{"code":"CP17744631831415267","type":"CDM"},{"code":"250","type":"RC"},{"code":"24112","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Qelbree      Cap 100mg Er","code_information":[{"code":"CP17744631830853783","type":"CDM"},{"code":"250","type":"RC"},{"code":"17772013130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Qelbree      Cap 200mg Er","code_information":[{"code":"CP17744631830854904","type":"CDM"},{"code":"250","type":"RC"},{"code":"17772013330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Oxtellar Xr  Tab 300mg","code_information":[{"code":"CP17744631830700762","type":"CDM"},{"code":"250","type":"RC"},{"code":"17772012201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831113871","type":"CDM"},{"code":"250","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831111833","type":"CDM"},{"code":"250","type":"RC"},{"code":"57408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Zestoretic   Tab 20-12.5","code_information":[{"code":"CP17744631831393412","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427043690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Diovan       Tab 320mg","code_information":[{"code":"CP17744631829703074","type":"CDM"},{"code":"250","type":"RC"},{"code":"78036","type":"CPT","modifier":"34"}],"standard_charges":[{"setting":"outpatient","modifier_code":["34"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Iv Statlock Picc Pls Foam","code_information":[{"code":"CP17744631830178676","type":"CDM"},{"code":"250","type":"RC"},{"code":"24026","type":"CPT","modifier":"53"}],"standard_charges":[{"setting":"outpatient","modifier_code":["53"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adrenalin    Inj 1mg/ml","code_information":[{"code":"CP17744631828354765","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023015925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Xtampza Er   Cap 18mg","code_information":[{"code":"CP17744631831381753","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510012010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Xtampza Er 18mg Caps","code_information":[{"code":"CP17744631831382710","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510012010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Concerta     Tab 27mg","code_information":[{"code":"CP17744631829415072","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":27,"type":"ME"}},{"description":"Eucrisa      Oin 2%","code_information":[{"code":"CP17744631829822945","type":"CDM"},{"code":"250","type":"RC"},{"code":"55724021121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Eucrisa 2% Oint","code_information":[{"code":"CP17744631829829069","type":"CDM"},{"code":"250","type":"RC"},{"code":"55724021121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Bimatoprost  Sol 0.03%","code_information":[{"code":"CP17744631828886827","type":"CDM"},{"code":"250","type":"RC"},{"code":"78162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Banzel       Tab 200mg","code_information":[{"code":"CP17744631828838417","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856058252","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cipro/dex Otic Susp 0.3/0.1%","code_information":[{"code":"CP17744631829239923","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598032675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Cipro/dexa   Sus 0.3-0.1%","code_information":[{"code":"CP17744631829232798","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598032675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Dovonex      Cre 0.005%","code_information":[{"code":"CP17744631829737379","type":"CDM"},{"code":"250","type":"RC"},{"code":"50222026006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Anti-e K-h Ot 15-20wh","code_information":[{"code":"CP17744631828720236","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318959929","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti-e K-h Ot 15-20wh Ss","code_information":[{"code":"CP17744631828726729","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318959926","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Movantik     Tab 12.5mg","code_information":[{"code":"CP17744631830514954","type":"CDM"},{"code":"250","type":"RC"},{"code":"57841130001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Movantik     Tab 25mg","code_information":[{"code":"CP17744631830517137","type":"CDM"},{"code":"250","type":"RC"},{"code":"57841130101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Movantik     Tab 25mg","code_information":[{"code":"CP17744631830517922","type":"CDM"},{"code":"250","type":"RC"},{"code":"57841130103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Strattera    Cap 25mg","code_information":[{"code":"CP17744631831073027","type":"CDM"},{"code":"250","type":"RC"},{"code":"23228","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sumatriptan  Spr 20mg/act","code_information":[{"code":"CP17744631831082938","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802059806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ace Wrist    Mis Brace/sp","code_information":[{"code":"CP17744631828181574","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131019835","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Coccyx Cushion","code_information":[{"code":"CP17744631829395810","type":"CDM"},{"code":"250","type":"RC"},{"code":"54756051001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zenpep       Cap 10000unt","code_information":[{"code":"CP17744631831394955","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Cefixime     Cap 400mg","code_information":[{"code":"CP17744631829173417","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180042311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Albuterol    Neb 1.25mg/3","code_information":[{"code":"CP17744631828385339","type":"CDM"},{"code":"250","type":"RC"},{"code":"37870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Gnp First    Kit Aid","code_information":[{"code":"CP17744631830059376","type":"CDM"},{"code":"250","type":"RC"},{"code":"87701042522","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medroxypr Ac Inj 150mg/ml","code_information":[{"code":"CP17744631830401133","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Onfi         Sus 2.5mg/ml","code_information":[{"code":"CP17744631830696873","type":"CDM"},{"code":"250","type":"RC"},{"code":"67386031321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vaseretic 10-25 Tab","code_information":[{"code":"CP17744631831250907","type":"CDM"},{"code":"250","type":"RC"},{"code":"18701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pancreaze    Cap 2600unit","code_information":[{"code":"CP17744631830735369","type":"CDM"},{"code":"250","type":"RC"},{"code":"62541040110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2600,"type":"UN"}},{"description":"Estradiol    Dis 0.075mg","code_information":[{"code":"CP17744631829828241","type":"CDM"},{"code":"250","type":"RC"},{"code":"37833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Lido/prilocn Cre 2.5-2.5%","code_information":[{"code":"CP17744631830326432","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Loteprednol  Sus 0.5%","code_information":[{"code":"CP17744631830379828","type":"CDM"},{"code":"250","type":"RC"},{"code":"82260029905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Mavenof50mg","code_information":[{"code":"CP17744631830408306","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nj Venofer 50mg/50ml Ns","code_information":[{"code":"CP17744631830576119","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Venofer      Inj 20mg/ml","code_information":[{"code":"CP17744631831264246","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Venofer      Inj 20mg/ml","code_information":[{"code":"CP17744631831267536","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Venofer      Inj 20mg/ml","code_information":[{"code":"CP17744631831261091","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Venofer 100mg In 100ml Ns","code_information":[{"code":"CP17744631831264269","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venofer 100mg In 100ml Ns","code_information":[{"code":"CP17744631831268671","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venofer 100mg/100ml Ns","code_information":[{"code":"CP17744631831267593","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venofer 100mg/100ml Ns","code_information":[{"code":"CP17744631831268390","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venofer 125mg/100ml Ns","code_information":[{"code":"CP17744631831269797","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Venofer 200 Mg/100 Ml Ns El-j","code_information":[{"code":"CP17744631831264408","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Venofer 200 Mg/100 Ml Ns El-j","code_information":[{"code":"CP17744631831265180","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Venofer 200mg In 100ml Ns","code_information":[{"code":"CP17744631831267137","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Venofer 200mg/100ml Nacl","code_information":[{"code":"CP17744631831264255","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Venofer 200mg/100ml Nacl","code_information":[{"code":"CP17744631831268608","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Venofer 200mg/100ml Ns","code_information":[{"code":"CP17744631831269982","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Venofer 300mg In 250ml","code_information":[{"code":"CP17744631831261435","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Venofer 300mg/250ml","code_information":[{"code":"CP17744631831265497","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Venofer 32mg In 100ml Ns","code_information":[{"code":"CP17744631831264198","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Venofer 500mg In 250ml","code_information":[{"code":"CP17744631831261184","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Venofer 50mg In 50ml","code_information":[{"code":"CP17744631831262506","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Venofer 50mg/50ml","code_information":[{"code":"CP17744631831262713","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Venofer 50mg/50ml 0.9% Nacl","code_information":[{"code":"CP17744631831263676","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Venofer 50mg/50ml Ns","code_information":[{"code":"CP17744631831264850","type":"CDM"},{"code":"250","type":"RC"},{"code":"51723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Roflumilast  Tab 250mcg","code_information":[{"code":"CP17744631830914565","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020124","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Rozerem      Tab 8mg","code_information":[{"code":"CP17744631830924160","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764080530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Vyvanse      Cap 10mg","code_information":[{"code":"CP17744631831302610","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vyvanse      Cap 20mg","code_information":[{"code":"CP17744631831300143","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vyvanse      Cap 30mg","code_information":[{"code":"CP17744631831308409","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Vyvanse      Cap 40mg","code_information":[{"code":"CP17744631831307103","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Vyvanse      Cap 50mg","code_information":[{"code":"CP17744631831309601","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vyvanse      Cap 60mg","code_information":[{"code":"CP17744631831309213","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Vyvanse      Cap 70mg","code_information":[{"code":"CP17744631831307315","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Vyvanse 60mg Caps","code_information":[{"code":"CP17744631831306124","type":"CDM"},{"code":"250","type":"RC"},{"code":"59417010610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ampicil/sulb 1.5 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828521998","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Ampicillin/sulb 3 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828529426","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ampicillin/sulb 3 Gm/100ml Mb","code_information":[{"code":"CP17744631828522286","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Ns","code_information":[{"code":"CP17744631829158097","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Imipenem/cil 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830137284","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Imipenem/cilast 400mg/100ml Ns","code_information":[{"code":"CP17744631830135296","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Imipenem/cilast 500mg/100ml Ns","code_information":[{"code":"CP17744631830136599","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ns 0.9% Mb+","code_information":[{"code":"CP17744631830640413","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Piper/tazbac2.25g/100ml Ns Mb","code_information":[{"code":"CP17744631830777210","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830782130","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Sod Chloride 0.9% Mb+ 100ml","code_information":[{"code":"CP17744631831049801","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831046538","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sodium Chloride 0.9% Mb 100ml","code_information":[{"code":"CP17744631831046101","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ritalin La   Cap 30mg","code_information":[{"code":"CP17744631830901652","type":"CDM"},{"code":"250","type":"RC"},{"code":"78037","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Concerta     Tab 18mg","code_information":[{"code":"CP17744631829413347","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458058501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829786943","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714002610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Enoxaparin 60mg/0.6 Ml Dose","code_information":[{"code":"CP17744631829781800","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714002610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Gablofen     Inj 10000/20","code_information":[{"code":"CP17744631830018389","type":"CDM"},{"code":"250","type":"RC"},{"code":"66794015502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Invega       Tab 3mg","code_information":[{"code":"CP17744631830150719","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458055001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Invega       Tab 6mg","code_information":[{"code":"CP17744631830156775","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458055101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Ztlido       Pad 1.8%","code_information":[{"code":"CP17744631831418912","type":"CDM"},{"code":"250","type":"RC"},{"code":"69557011130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vesicare     Tab 10mg","code_information":[{"code":"CP17744631831262198","type":"CDM"},{"code":"250","type":"RC"},{"code":"51248015101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vesicare     Tab 5mg","code_information":[{"code":"CP17744631831261476","type":"CDM"},{"code":"250","type":"RC"},{"code":"51248015001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Vesicare 5mg Tabs","code_information":[{"code":"CP17744631831264862","type":"CDM"},{"code":"250","type":"RC"},{"code":"51248015001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Adderall     Tab 20mg","code_information":[{"code":"CP17744631828342266","type":"CDM"},{"code":"250","type":"RC"},{"code":"57844012001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Halog        Cre 0.1%","code_information":[{"code":"CP17744631830061768","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631009430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Halog 0.1% Ointment","code_information":[{"code":"CP17744631830061240","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631009630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydralazine  Inj 20mg/ml","code_information":[{"code":"CP17744631830092009","type":"CDM"},{"code":"250","type":"RC"},{"code":"64162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Voltaren     Gel 1%","code_information":[{"code":"CP17744631831309891","type":"CDM"},{"code":"250","type":"RC"},{"code":"67815","type":"CPT","modifier":"202"}],"standard_charges":[{"setting":"outpatient","modifier_code":["202"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Voltaren     Gel 1% Arthr","code_information":[{"code":"CP17744631831306318","type":"CDM"},{"code":"250","type":"RC"},{"code":"67815","type":"CPT","modifier":"202"}],"standard_charges":[{"setting":"outpatient","modifier_code":["202"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compress Stock Th Large","code_information":[{"code":"CP17744631829411251","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin 300mg/3ml Inj","code_information":[{"code":"CP17744631829787000","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Marinol      Cap 2.5mg","code_information":[{"code":"CP17744631830408332","type":"CDM"},{"code":"250","type":"RC"},{"code":"53097057160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Saxagliptin-metformn Er 5-1000","code_information":[{"code":"CP17744631830998712","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598061930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking K-h 20-30 Xl","code_information":[{"code":"CP17744631831065453","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960223","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Emtricitabin Cap 200mg","code_information":[{"code":"CP17744631829771317","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097064202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Testost Enan Inj 200mg/ml","code_information":[{"code":"CP17744631831118614","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Viibryd      Tab 10mg","code_information":[{"code":"CP17744631831279070","type":"CDM"},{"code":"250","type":"RC"},{"code":"45611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Viibryd      Tab 20mg","code_information":[{"code":"CP17744631831274803","type":"CDM"},{"code":"250","type":"RC"},{"code":"45611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Viibryd      Tab 40mg","code_information":[{"code":"CP17744631831270389","type":"CDM"},{"code":"250","type":"RC"},{"code":"45611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Viibryd 10mg Tabs","code_information":[{"code":"CP17744631831270776","type":"CDM"},{"code":"250","type":"RC"},{"code":"45611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Viibryd 40mg Tabs","code_information":[{"code":"CP17744631831275046","type":"CDM"},{"code":"250","type":"RC"},{"code":"45611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Clindamycin  Gel 1%","code_information":[{"code":"CP17744631829251861","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714016101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830697213","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380079701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830698137","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342025666","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir 30mg Caps","code_information":[{"code":"CP17744631830692644","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380079701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ziprasidone  Inj 20mg","code_information":[{"code":"CP17744631831409233","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266016010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Levobunolol  Sol 0.5% Op","code_information":[{"code":"CP17744631830303255","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208050505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Sirolimus    Tab 1mg","code_information":[{"code":"CP17744631831027919","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyclogyl     Sol 1% Op","code_information":[{"code":"CP17744631829448075","type":"CDM"},{"code":"250","type":"RC"},{"code":"65039","type":"CPT","modifier":"605"}],"standard_charges":[{"setting":"outpatient","modifier_code":["605"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Deferasirox  Tab 250mg","code_information":[{"code":"CP17744631829540680","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452016013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"First Aid Kit Complete","code_information":[{"code":"CP17744631829956756","type":"CDM"},{"code":"250","type":"RC"},{"code":"84389010856","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Qudexy Xr    Cap 50/24hr","code_information":[{"code":"CP17744631830865218","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Eucerin Adv  Cre Repair","code_information":[{"code":"CP17744631829828545","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140002049","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eucerin Inten Repair Cr","code_information":[{"code":"CP17744631829829985","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140002049","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Collagen Dressing Sheet","code_information":[{"code":"CP17744631829406375","type":"CDM"},{"code":"250","type":"RC"},{"code":"42311","type":"CPT","modifier":"500"}],"standard_charges":[{"setting":"outpatient","modifier_code":["500"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxepin      Tab 3mg","code_information":[{"code":"CP17744631829733934","type":"CDM"},{"code":"250","type":"RC"},{"code":"44183010330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Everolimus   Tab 1mg","code_information":[{"code":"CP17744631829834388","type":"CDM"},{"code":"250","type":"RC"},{"code":"54060","type":"CPT","modifier":"421"}],"standard_charges":[{"setting":"outpatient","modifier_code":["421"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Eye Itch Rel Dro 0.025%op","code_information":[{"code":"CP17744631829833744","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eye Itch Rel Dro 0.035%op","code_information":[{"code":"CP17744631829830717","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketotifen Eye Itch 0.025% Sol","code_information":[{"code":"CP17744631830197002","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Fentanyl     Dis 100mcg/h","code_information":[{"code":"CP17744631829855747","type":"CDM"},{"code":"250","type":"RC"},{"code":"40691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nephronex    Liq 0.9/5ml","code_information":[{"code":"CP17744631830556014","type":"CDM"},{"code":"250","type":"RC"},{"code":"54859051608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Elmiron      Cap 100mg","code_information":[{"code":"CP17744631829775809","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458009801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Elmiron 100mg Caps","code_information":[{"code":"CP17744631829776244","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458009801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Admelog Solo 100 Units/ml 3ml","code_information":[{"code":"CP17744631828356705","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"505"}],"standard_charges":[{"setting":"outpatient","modifier_code":["505"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Admelog Solo Inj 100u/ml","code_information":[{"code":"CP17744631828359168","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"505"}],"standard_charges":[{"setting":"outpatient","modifier_code":["505"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Admelog Solostar 100iu/ml Sopn","code_information":[{"code":"CP17744631828356196","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"505"}],"standard_charges":[{"setting":"outpatient","modifier_code":["505"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"F2"}},{"description":"Insulin Lisp Inj 100/ml","code_information":[{"code":"CP17744631830149385","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"505"}],"standard_charges":[{"setting":"outpatient","modifier_code":["505"],"minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Farxiga      Tab 10mg","code_information":[{"code":"CP17744631829845015","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Seroquel     Tab 200mg","code_information":[{"code":"CP17744631831002633","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Travoprost   Dro 0.004%","code_information":[{"code":"CP17744631831168607","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505059304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Neb 0.5%","code_information":[{"code":"CP17744631828389890","type":"CDM"},{"code":"250","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Albuterol 0.5%","code_information":[{"code":"CP17744631828397313","type":"CDM"},{"code":"250","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol 0.5% Neb Sol 30 Vial","code_information":[{"code":"CP17744631828397285","type":"CDM"},{"code":"250","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Albuterol 0.5% Nebulizer","code_information":[{"code":"CP17744631828397186","type":"CDM"},{"code":"250","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Albuterol Neb 0.5%","code_information":[{"code":"CP17744631828396310","type":"CDM"},{"code":"250","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Currently On Backorder","code_information":[{"code":"CP17744631829437624","type":"CDM"},{"code":"250","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Not Available","code_information":[{"code":"CP17744631830578656","type":"CDM"},{"code":"250","type":"RC"},{"code":"48799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Plexion Clth Pad 9.8-4.8%","code_information":[{"code":"CP17744631830788646","type":"CDM"},{"code":"250","type":"RC"},{"code":"57883040460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830658399","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo-polycin  Oin Op","code_information":[{"code":"CP17744631830551056","type":"CDM"},{"code":"250","type":"RC"},{"code":"57442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Colistimeth  Inj 150mg","code_information":[{"code":"CP17744631829404282","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594002301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Colistimethate 150mg/100ml Ns","code_information":[{"code":"CP17744631829402046","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594002301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Colistimethate 150mg/2ml","code_information":[{"code":"CP17744631829409939","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594002301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Emtricitabin Cap 200mg","code_information":[{"code":"CP17744631829772550","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862030130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Imiquimod    Cre 5%","code_information":[{"code":"CP17744631830132428","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802036862","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ipratrop Bromi-0.03%-345sprays","code_information":[{"code":"CP17744631830151506","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714052601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Ipratropium  Spr 0.03%","code_information":[{"code":"CP17744631830158392","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714052601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Medihoney    Pad 2\"x2\"","code_information":[{"code":"CP17744631830405495","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":13,"gross_charge":13,"discounted_cash":13,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":13},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hemp Oil","code_information":[{"code":"CP17744631830074959","type":"CDM"},{"code":"250","type":"RC"},{"code":"1054040749","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylp Ss 1000 In 250ml Ns","code_information":[{"code":"CP17744631830440700","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598013074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Methylp Ss 500 In 100 Ml Ns","code_information":[{"code":"CP17744631830442179","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598013074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Methylpr Ss  Inj 1000mg","code_information":[{"code":"CP17744631830457556","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598013074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Onglyza      Tab 5mg","code_information":[{"code":"CP17744631830699414","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862082630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Saxagliptin  Tab 5mg","code_information":[{"code":"CP17744631830990242","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862082630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Intelence    Tab 100mg","code_information":[{"code":"CP17744631830156968","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676057001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lubricath    Mis 20french","code_information":[{"code":"CP17744631830385602","type":"CDM"},{"code":"250","type":"RC"},{"code":"8011016620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocortiso Cre 2.5%","code_information":[{"code":"CP17744631830117812","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydrocortisone 2.5% Cream","code_information":[{"code":"CP17744631830112961","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Nyst10k-hydroc-zinc Oxide-alum","code_information":[{"code":"CP17744631830642968","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830654531","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/zinc/triple_abx","code_information":[{"code":"CP17744631830656256","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rytary       Cap 145mg","code_information":[{"code":"CP17744631830921834","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Rytary 36.25/145mg","code_information":[{"code":"CP17744631830927398","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896066201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3625,"type":"ME"}},{"description":"Ammonium Lac Lot 12%","code_information":[{"code":"CP17744631828498177","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Ammonium Lactate 12% Lotn (R)","code_information":[{"code":"CP17744631828492133","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Ammonium Lactate/triamcin","code_information":[{"code":"CP17744631828497029","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829785392","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714004610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Triamcinolon Pst Den 0.1%","code_information":[{"code":"CP17744631831180245","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Norvasc      Tab 10mg","code_information":[{"code":"CP17744631830574297","type":"CDM"},{"code":"250","type":"RC"},{"code":"69154","type":"CPT","modifier":"68"}],"standard_charges":[{"setting":"outpatient","modifier_code":["68"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Norvasc      Tab 10mg","code_information":[{"code":"CP17744631830574633","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151035577","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cefazol/dex  Sol 1gm","code_information":[{"code":"CP17744631829143383","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Insulin Lisp Inj 100/ml","code_information":[{"code":"CP17744631830147883","type":"CDM"},{"code":"250","type":"RC"},{"code":"66733077301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insulin Lispro 100unit/ml Soln","code_information":[{"code":"CP17744631830144683","type":"CDM"},{"code":"250","type":"RC"},{"code":"66733077301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Quad Cane Al Chrome","code_information":[{"code":"CP17744631830865217","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247922269","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Galzin       Cap 50mg","code_information":[{"code":"CP17744631830027337","type":"CDM"},{"code":"250","type":"RC"},{"code":"57844020852","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Belbuca      Mis 300mcg","code_information":[{"code":"CP17744631828856848","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Lofexidine   Tab 0.18mg","code_information":[{"code":"CP17744631830352482","type":"CDM"},{"code":"250","type":"RC"},{"code":"71921025036","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Silver Alginate Sorbalgon","code_information":[{"code":"CP17744631831018783","type":"CDM"},{"code":"250","type":"RC"},{"code":"10861","type":"CPT","modifier":"90"}],"standard_charges":[{"setting":"outpatient","modifier_code":["90"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vimpat       Tab 50mg","code_information":[{"code":"CP17744631831270367","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vimpat 50mg Tabs","code_information":[{"code":"CP17744631831276254","type":"CDM"},{"code":"250","type":"RC"},{"code":"13124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Anti-emb Bl-kn Ct","code_information":[{"code":"CP17744631828720497","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958795","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti-emb Bl-kn Lg 15-20 Ss","code_information":[{"code":"CP17744631828723581","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958795","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti-emb Stockin  Bl Knee","code_information":[{"code":"CP17744631828722898","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958796","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol    Dis 0.05mg","code_information":[{"code":"CP17744631829813146","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Xiidra       Dro 5%","code_information":[{"code":"CP17744631831386330","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrofera    Pad Mrf4\"x4\"","code_information":[{"code":"CP17744631830115639","type":"CDM"},{"code":"250","type":"RC"},{"code":"8573044414","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydromorphon Tab 16mg Er","code_information":[{"code":"CP17744631830117423","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722012101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Pregabalin   Cap 300mg","code_information":[{"code":"CP17744631830827421","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830823959","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830992458","type":"CDM"},{"code":"250","type":"RC"},{"code":"37864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Scopolamine 1mg/3days Patch","code_information":[{"code":"CP17744631830996292","type":"CDM"},{"code":"250","type":"RC"},{"code":"37864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Eszopiclone  Tab 1mg","code_information":[{"code":"CP17744631829827925","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862096701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Invega       Tab 1.5mg","code_information":[{"code":"CP17744631830150239","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458055401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Moxifloxacin 400mg Tabs","code_information":[{"code":"CP17744631830517787","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862060330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Moxifloxacin Tab 400mg","code_information":[{"code":"CP17744631830515161","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862060330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Bepotastine  Dro 1.5% Op","code_information":[{"code":"CP17744631828864859","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332059805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Differin     Gel 0.3%","code_information":[{"code":"CP17744631829604082","type":"CDM"},{"code":"250","type":"RC"},{"code":"29959","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Enoxaparin 100mg/ml Inj Soln","code_information":[{"code":"CP17744631829784530","type":"CDM"},{"code":"250","type":"RC"},{"code":"78135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enoxaparin 80mg/0.8ml Inj","code_information":[{"code":"CP17744631829785796","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Lamotrigine  Kit Start 35","code_information":[{"code":"CP17744631830219895","type":"CDM"},{"code":"250","type":"RC"},{"code":"69102063909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 30/0.3ml","code_information":[{"code":"CP17744631829784053","type":"CDM"},{"code":"250","type":"RC"},{"code":"78131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Uceris       Aer 2mg/act","code_information":[{"code":"CP17744631831200798","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649065103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"E.e.s. 400   Tab 400mg","code_information":[{"code":"CP17744631829768585","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338010003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Rythmol Sr   Cap 225mg","code_information":[{"code":"CP17744631830922403","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Entresto     Cap 15-16mg","code_information":[{"code":"CP17744631829794165","type":"CDM"},{"code":"250","type":"RC"},{"code":"78123","type":"CPT","modifier":"820"}],"standard_charges":[{"setting":"outpatient","modifier_code":["820"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Entresto     Cap 6-6mg","code_information":[{"code":"CP17744631829799629","type":"CDM"},{"code":"250","type":"RC"},{"code":"78123","type":"CPT","modifier":"120"}],"standard_charges":[{"setting":"outpatient","modifier_code":["120"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Entresto     Tab 97-103mg","code_information":[{"code":"CP17744631829798041","type":"CDM"},{"code":"250","type":"RC"},{"code":"78069","type":"CPT","modifier":"667"}],"standard_charges":[{"setting":"outpatient","modifier_code":["667"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":97,"type":"ME"}},{"description":"Dayvigo      Tab 10mg","code_information":[{"code":"CP17744631829548002","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856041030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dayvigo      Tab 5mg","code_information":[{"code":"CP17744631829541835","type":"CDM"},{"code":"250","type":"RC"},{"code":"62856040530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Quinidine Su Tab 300mg","code_information":[{"code":"CP17744631830877932","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806051230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lurasidone   Tab 120mg","code_information":[{"code":"CP17744631830387704","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162088203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Iodoflex     Pad Pad","code_information":[{"code":"CP17744631830153429","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565012251","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fosrenol     Pow 1000mg","code_information":[{"code":"CP17744631829993374","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092025702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Lamictal     Tab 150mg","code_information":[{"code":"CP17744631830204113","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Anti-em Knee Mis Med Reg","code_information":[{"code":"CP17744631828729662","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664011472","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Benztropine  Inj 1mg/ml","code_information":[{"code":"CP17744631828860700","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Double Toe Straightener","code_information":[{"code":"CP17744631829724844","type":"CDM"},{"code":"250","type":"RC"},{"code":"92437081570","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hand Exerciser Palm Grip","code_information":[{"code":"CP17744631830077688","type":"CDM"},{"code":"250","type":"RC"},{"code":"65070000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonidine    Dis 0.3/24hr","code_information":[{"code":"CP17744631829382460","type":"CDM"},{"code":"250","type":"RC"},{"code":"37808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Toviaz       Tab 8mg","code_information":[{"code":"CP17744631831159392","type":"CDM"},{"code":"250","type":"RC"},{"code":"69024","type":"CPT","modifier":"430"}],"standard_charges":[{"setting":"outpatient","modifier_code":["430"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828389024","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204020060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Albuterol 0.083% Neb Sol 3ml","code_information":[{"code":"CP17744631828387080","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204020060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Diclofenac   Gel 1%","code_information":[{"code":"CP17744631829595811","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Knee Brace Slip-on Lg","code_information":[{"code":"CP17744631830195344","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189001693","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Gel 2%","code_information":[{"code":"CP17744631830335556","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Unna-flex    Mis 3\"x10yd","code_information":[{"code":"CP17744631831214395","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010763","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Athletic Supporter Wrap","code_information":[{"code":"CP17744631828770983","type":"CDM"},{"code":"250","type":"RC"},{"code":"40659","type":"CPT","modifier":"8"}],"standard_charges":[{"setting":"outpatient","modifier_code":["8"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine   Tab 20mg","code_information":[{"code":"CP17744631830662692","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine 20mg Tabs","code_information":[{"code":"CP17744631830674498","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Voriconazole Tab 200mg","code_information":[{"code":"CP17744631831305807","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462057330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Voriconazole Tab 200mg","code_information":[{"code":"CP17744631831306801","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241006303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Everolimus   Tab 0.75mg","code_information":[{"code":"CP17744631829833099","type":"CDM"},{"code":"250","type":"RC"},{"code":"54047","type":"CPT","modifier":"221"}],"standard_charges":[{"setting":"outpatient","modifier_code":["221"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cerave       Cre Moisturi","code_information":[{"code":"CP17744631829190544","type":"CDM"},{"code":"250","type":"RC"},{"code":"6000053766","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fenofibrate  Tab 120mg","code_information":[{"code":"CP17744631829850137","type":"CDM"},{"code":"250","type":"RC"},{"code":"37843","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Proventil    Aer Hfa","code_information":[{"code":"CP17744631830852947","type":"CDM"},{"code":"250","type":"RC"},{"code":"85113","type":"CPT","modifier":"204"}],"standard_charges":[{"setting":"outpatient","modifier_code":["204"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proventil    Aer Hfa","code_information":[{"code":"CP17744631830857134","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758095985","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proventil Hfa 108mcg","code_information":[{"code":"CP17744631830854580","type":"CDM"},{"code":"250","type":"RC"},{"code":"85113","type":"CPT","modifier":"204"}],"standard_charges":[{"setting":"outpatient","modifier_code":["204"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":108,"type":"ME"}},{"description":"Steglatro    Tab 15mg","code_information":[{"code":"CP17744631831066289","type":"CDM"},{"code":"250","type":"RC"},{"code":"65364","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Steglatro    Tab 5mg","code_information":[{"code":"CP17744631831066026","type":"CDM"},{"code":"250","type":"RC"},{"code":"65363","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Xifaxan      Tab 200mg","code_information":[{"code":"CP17744631831382922","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649030103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Xifaxan 200mg Tabs","code_information":[{"code":"CP17744631831388402","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649030103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Systane Gel  Dro 0.4-0.3%","code_information":[{"code":"CP17744631831097497","type":"CDM"},{"code":"250","type":"RC"},{"code":"65045","type":"CPT","modifier":"407"}],"standard_charges":[{"setting":"outpatient","modifier_code":["407"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Theo-24      Cap 200mg Cr","code_information":[{"code":"CP17744631831120716","type":"CDM"},{"code":"250","type":"RC"},{"code":"52244020010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Arm Sling Shoulder","code_information":[{"code":"CP17744631828752740","type":"CDM"},{"code":"250","type":"RC"},{"code":"72979845482","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 100mcg/h","code_information":[{"code":"CP17744631829853254","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fentanyl     Dis 100mcg/h","code_information":[{"code":"CP17744631829856061","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042847","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tetrabenazin Tab 12.5mg","code_information":[{"code":"CP17744631831117265","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436010109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Tetrabenazin Tab 12.5mg","code_information":[{"code":"CP17744631831111905","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452011721","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Foley Catheter 16fr 10 Cc","code_information":[{"code":"CP17744631829997963","type":"CDM"},{"code":"250","type":"RC"},{"code":"11216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830484716","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817032510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ice It Cvr/  Mis Str6\"x9\"","code_information":[{"code":"CP17744631830136677","type":"CDM"},{"code":"250","type":"RC"},{"code":"40337000530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 20mg Cr","code_information":[{"code":"CP17744631830715294","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxycontin    Tab 20mg Er","code_information":[{"code":"CP17744631830713551","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011042020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Theratears   Sol 0.25% Pf","code_information":[{"code":"CP17744631831123758","type":"CDM"},{"code":"250","type":"RC"},{"code":"58790000030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Lamictal     Chw 25mg","code_information":[{"code":"CP17744631830200041","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831113287","type":"CDM"},{"code":"250","type":"RC"},{"code":"57408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Testosterone 200mg/ml Soln","code_information":[{"code":"CP17744631831111321","type":"CDM"},{"code":"250","type":"RC"},{"code":"57408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Beconase Aq  Sus 0.042%","code_information":[{"code":"CP17744631828841255","type":"CDM"},{"code":"250","type":"RC"},{"code":"17303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":42,"type":"EA"}},{"description":"Fluphenaz De Inj 25mg/ml","code_information":[{"code":"CP17744631829974170","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Elastomeric Pump250/250ml","code_information":[{"code":"CP17744631829766711","type":"CDM"},{"code":"250","type":"RC"},{"code":"62502500000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Futuro X-lg  Mis Knee Brc","code_information":[{"code":"CP17744631830017601","type":"CDM"},{"code":"250","type":"RC"},{"code":"8225004406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Topiramate   Cap Er 150mg","code_information":[{"code":"CP17744631831158547","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ciclopirox   Cre 0.77%","code_information":[{"code":"CP17744631829227417","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672131808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Drug Buster-16 Oz","code_information":[{"code":"CP17744631829754722","type":"CDM"},{"code":"250","type":"RC"},{"code":"88438919802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glyxambi     Tab 10-5 Mg","code_information":[{"code":"CP17744631830053233","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Jardiance    Tab 25mg","code_information":[{"code":"CP17744631830189560","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Jardiance    Tab 25mg","code_information":[{"code":"CP17744631830181176","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830768296","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714097302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Roflumilast  Tab 250mcg","code_information":[{"code":"CP17744631830913451","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Synjardy Xr  Tab 10-1000","code_information":[{"code":"CP17744631831088122","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Synjardy Xr  Tab 25-1000","code_information":[{"code":"CP17744631831085281","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Synjardy Xr 10/1000mg Tab","code_information":[{"code":"CP17744631831082820","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Synjardy Xr 10/100mg Tab","code_information":[{"code":"CP17744631831082551","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Terconazole  Sup 80mg","code_information":[{"code":"CP17744631831117015","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Fentanyl     Dis 50mcg/hr","code_information":[{"code":"CP17744631829854979","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042647","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydrocort Ac Sup 30mg","code_information":[{"code":"CP17744631830115988","type":"CDM"},{"code":"250","type":"RC"},{"code":"57470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Bed Wedge    Mis 10\"","code_information":[{"code":"CP17744631828850936","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703078545","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stimulen     Pow","code_information":[{"code":"CP17744631831066251","type":"CDM"},{"code":"250","type":"RC"},{"code":"45713099501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy      Aer 100mcg","code_information":[{"code":"CP17744631831164326","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Trelegy      Aer 200mcg","code_information":[{"code":"CP17744631831168388","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Trelegy      Aer Ellipta","code_information":[{"code":"CP17744631831165024","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy      Aer Ellipta","code_information":[{"code":"CP17744631831161528","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Aer 100-62.5-25 30inh","code_information":[{"code":"CP17744631831167533","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Trelegy Aer 100-62.5-25 60inh","code_information":[{"code":"CP17744631831164636","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Trelegy Aer 200-62.5-25 30inh","code_information":[{"code":"CP17744631831161701","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Trelegy Aer 200-62.5-25 60inh","code_information":[{"code":"CP17744631831164789","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Trelegy Ellipt Aer 100-62.5-25","code_information":[{"code":"CP17744631831163412","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Trelegy Ellipt Aer100/30 Doses","code_information":[{"code":"CP17744631831164315","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Trelegy Ellipta 100-62.5-25","code_information":[{"code":"CP17744631831166093","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 100-62.5-25mcg","code_information":[{"code":"CP17744631831161079","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Trelegy Ellipta 200/30 Doses","code_information":[{"code":"CP17744631831162045","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 200-62.5-25","code_information":[{"code":"CP17744631831174068","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trelegy Ellipta 200-62.5-25mcg","code_information":[{"code":"CP17744631831174474","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Abreva       Cre 10%","code_information":[{"code":"CP17744631828144327","type":"CDM"},{"code":"250","type":"RC"},{"code":"13502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Abreva       Cre 10%","code_information":[{"code":"CP17744631828143153","type":"CDM"},{"code":"250","type":"RC"},{"code":"13503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Abreva       Cre 10%","code_information":[{"code":"CP17744631828141901","type":"CDM"},{"code":"250","type":"RC"},{"code":"13502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Abreva 10% Cream","code_information":[{"code":"CP17744631828147971","type":"CDM"},{"code":"250","type":"RC"},{"code":"13502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Clonidine    Dis 0.3/24hr","code_information":[{"code":"CP17744631829378730","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907002548","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonidine    Dis 0.3/24hr","code_information":[{"code":"CP17744631829373959","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862045504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonidine 0.3mg/24hr Patch","code_information":[{"code":"CP17744631829380854","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862045504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rifabutin    Cap 150mg","code_information":[{"code":"CP17744631830896611","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135073801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Clonidine    Dis 0.3/24hr","code_information":[{"code":"CP17744631829381672","type":"CDM"},{"code":"250","type":"RC"},{"code":"59135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Octreotide   Inj 500mcg","code_information":[{"code":"CP17744631830653822","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ipratropium  Spr 0.06%","code_information":[{"code":"CP17744631830157319","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714052701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Naftin       Gel 1%","code_information":[{"code":"CP17744631830530504","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766077040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nafcillin    Inj 2gm","code_information":[{"code":"CP17744631830533429","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021014010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Isopto Atrop Sol 1% Op","code_information":[{"code":"CP17744631830163158","type":"CDM"},{"code":"250","type":"RC"},{"code":"65030","type":"CPT","modifier":"355"}],"standard_charges":[{"setting":"outpatient","modifier_code":["355"],"minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ammonium Lac Cre 12%","code_information":[{"code":"CP17744631828494163","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802049383","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Clomid       Tab 50mg","code_information":[{"code":"CP17744631829376446","type":"CDM"},{"code":"250","type":"RC"},{"code":"71308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ketorolac    Sol 0.4%","code_information":[{"code":"CP17744631830195807","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758077305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831110057","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097080232","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":10,"maximum":12,"gross_charge":12,"discounted_cash":12,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":12},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Clotrimazole 1% Cream","code_information":[{"code":"CP17744631829384488","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clotrimazole Cre 1%","code_information":[{"code":"CP17744631829383259","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Intrarosa    Sup 6.5mg","code_information":[{"code":"CP17744631830155631","type":"CDM"},{"code":"250","type":"RC"},{"code":"72495040128","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":65,"type":"ME"}},{"description":"Lotrisone/zinc Oxide 1:1","code_information":[{"code":"CP17744631830375286","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Poly-vi-flor Chw W/iron","code_information":[{"code":"CP17744631830781414","type":"CDM"},{"code":"250","type":"RC"},{"code":"23594010030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Silver Sulca /Clotrimazole Cre","code_information":[{"code":"CP17744631831016992","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thumb Stblzr Mis Sm/med","code_information":[{"code":"CP17744631831122211","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131019855","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lisdexamfeta Cap 20mg","code_information":[{"code":"CP17744631830342004","type":"CDM"},{"code":"250","type":"RC"},{"code":"54037","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Quinidine Su Tab 200mg","code_information":[{"code":"CP17744631830879109","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806051330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Wrist Brace- Rt Med","code_information":[{"code":"CP17744631831388444","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189001964","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wrist Brace-lt-med","code_information":[{"code":"CP17744631831381915","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189001960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lurasidone   Tab 120mg","code_information":[{"code":"CP17744631830381227","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862095730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Lurasidone   Tab 120mg","code_information":[{"code":"CP17744631830388668","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729035010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Lurasidone   Tab 120mg","code_information":[{"code":"CP17744631830382719","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342042307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Lacosamide   Tab 200mg","code_information":[{"code":"CP17744631830203769","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991035106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamictal     Tab 100mg","code_information":[{"code":"CP17744631830204665","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831091029","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291086630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831097448","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722064530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831094604","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722064630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831099935","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238134903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831094441","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668058130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831095918","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291086730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Latanoprost  Sol 0.005%","code_information":[{"code":"CP17744631830228317","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Vancomycin   Inj 750mg","code_information":[{"code":"CP17744631831238707","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323020320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830653846","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308015230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Depo-medrol  Inj 40mg/ml","code_information":[{"code":"CP17744631829552448","type":"CDM"},{"code":"250","type":"RC"},{"code":"93073","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tetrabenazin Tab 12.5mg","code_information":[{"code":"CP17744631831117838","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598039467","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Darunavir    Tab 800mg","code_information":[{"code":"CP17744631829544974","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180034606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Darunavir    Tab 800mg","code_information":[{"code":"CP17744631829541641","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651008630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Darunavir    Tab 800mg","code_information":[{"code":"CP17744631829543552","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205018530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Disulfiram   Tab 250mg","code_information":[{"code":"CP17744631829713094","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135043130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Sumatriptan  Tab 100mg","code_information":[{"code":"CP17744631831089521","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714079801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Knee Supprt Elastic Med","code_information":[{"code":"CP17744631830192242","type":"CDM"},{"code":"250","type":"RC"},{"code":"51331020099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mydayis      Cap 25mg","code_information":[{"code":"CP17744631830525376","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092047101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mydayis      Cap 50mg","code_information":[{"code":"CP17744631830529014","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092047701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Oxacillin    Inj 2gm","code_information":[{"code":"CP17744631830707971","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2gm/100ml D5w","code_information":[{"code":"CP17744631830706876","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2gm/100ml Ns","code_information":[{"code":"CP17744631830702320","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831098560","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fentanyl     Dis 50mcg/hr","code_information":[{"code":"CP17744631829850934","type":"CDM"},{"code":"250","type":"RC"},{"code":"40691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828795343","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dapaglif-met Tab 10-1000","code_information":[{"code":"CP17744631829472053","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993036230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Knee Hi 20-30 Med Man","code_information":[{"code":"CP17744631830192591","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189058782","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylpr Ace Inj 80mg/ml","code_information":[{"code":"CP17744631830459729","type":"CDM"},{"code":"250","type":"RC"},{"code":"70300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Neomy/poly B Irr 40/200,000","code_information":[{"code":"CP17744631830548692","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822122001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ranexa       Tab 1000mg","code_information":[{"code":"CP17744631830878643","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958100401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Stocking Knee Hi Man Lg","code_information":[{"code":"CP17744631831078153","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189058782","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloper Dec  Inj 50mg/ml","code_information":[{"code":"CP17744631830065121","type":"CDM"},{"code":"250","type":"RC"},{"code":"70371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Insulin Degl Inj 100unit","code_information":[{"code":"CP17744631830144570","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070040011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Degludec 100 Un/ml Mdv","code_information":[{"code":"CP17744631830144521","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070040011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Doxycycline  Cap 40mg","code_information":[{"code":"CP17744631829741231","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748030806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Easy Touch   Mis","code_information":[{"code":"CP17744631829762077","type":"CDM"},{"code":"250","type":"RC"},{"code":"8496080801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Benicar 40mg Tabs","code_information":[{"code":"CP17744631828855073","type":"CDM"},{"code":"250","type":"RC"},{"code":"65597010430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 120mg","code_information":[{"code":"CP17744631830385596","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205021130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Oxycodone    Sol 5mg/5ml","code_information":[{"code":"CP17744631830719221","type":"CDM"},{"code":"250","type":"RC"},{"code":"90466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fosamprenavir 700mg Tabs","code_information":[{"code":"CP17744631829999841","type":"CDM"},{"code":"250","type":"RC"},{"code":"37835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Acuvail      Sol 0.45%","code_information":[{"code":"CP17744631828328667","type":"CDM"},{"code":"250","type":"RC"},{"code":"23350","type":"CPT","modifier":"731"}],"standard_charges":[{"setting":"outpatient","modifier_code":["731"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831093517","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Exforge      Tab 5-160mg","code_information":[{"code":"CP17744631829835199","type":"CDM"},{"code":"250","type":"RC"},{"code":"78048","type":"CPT","modifier":"815"}],"standard_charges":[{"setting":"outpatient","modifier_code":["815"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Exforge Hct 5/160/12.5mg Tab","code_information":[{"code":"CP17744631829839867","type":"CDM"},{"code":"250","type":"RC"},{"code":"78055","type":"CPT","modifier":"915"}],"standard_charges":[{"setting":"outpatient","modifier_code":["915"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dapaglif Pro Tab 10mg","code_information":[{"code":"CP17744631829474579","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dapaglif Pro Tab 5mg","code_information":[{"code":"CP17744631829472932","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dapagliflozi Tab 10mg","code_information":[{"code":"CP17744631829470663","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dapagliflozi Tab 5mg","code_information":[{"code":"CP17744631829479183","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dapagliflozin Tab 10mg","code_information":[{"code":"CP17744631829477415","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dapagliflozin Tab 5mg","code_information":[{"code":"CP17744631829475738","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Farxiga      Tab 10mg","code_information":[{"code":"CP17744631829840527","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Farxiga      Tab 5mg","code_information":[{"code":"CP17744631829841364","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993045630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830786158","type":"CDM"},{"code":"250","type":"RC"},{"code":"52721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830784633","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598047060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830789999","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377003811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830785622","type":"CDM"},{"code":"250","type":"RC"},{"code":"25420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830780442","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722067760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830787712","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714015601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Posaconazole Tab 100mg Dr","code_information":[{"code":"CP17744631830784490","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714053501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Spiriva      Cap Handihlr","code_information":[{"code":"CP17744631831050714","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Spiriva Cap Handi 18mcg 30 Inh","code_information":[{"code":"CP17744631831057966","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Spiriva Handi 18mcg (30 Inh)","code_information":[{"code":"CP17744631831053718","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Hydrofera    Pad Blue 4x4","code_information":[{"code":"CP17744631830117686","type":"CDM"},{"code":"250","type":"RC"},{"code":"8573014414","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diazepam     Inj 5mg/ml","code_information":[{"code":"CP17744631829581774","type":"CDM"},{"code":"250","type":"RC"},{"code":"64162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Duobrii      Lot","code_information":[{"code":"CP17744631829751887","type":"CDM"},{"code":"250","type":"RC"},{"code":"18706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Megestrol Ac Sus 40mg/ml","code_information":[{"code":"CP17744631830413797","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094006362","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Zubsolv      Sub 2.9-0.71","code_information":[{"code":"CP17744631831413772","type":"CDM"},{"code":"250","type":"RC"},{"code":"54123092930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":29,"type":"EA"}},{"description":"Zubsolv      Sub 5.7-1.4","code_information":[{"code":"CP17744631831416604","type":"CDM"},{"code":"250","type":"RC"},{"code":"54123095730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":57,"type":"EA"}},{"description":"Droxidopa    Cap 200mg","code_information":[{"code":"CP17744631829753028","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722001590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Methyldopa   Tab 500mg","code_information":[{"code":"CP17744631830442492","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135032290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Sitagliptin  Tab 50mg","code_information":[{"code":"CP17744631831020989","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710190003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Apraclonidin Sol 0.5% Op","code_information":[{"code":"CP17744631828734138","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314066505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Droxidopa    Cap 200mg","code_information":[{"code":"CP17744631829758361","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304010490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Polyvinyl Al Sol 1.4% Op","code_information":[{"code":"CP17744631830783188","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268067815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":14,"type":"EA"}},{"description":"Zenzedi      Tab 20mg","code_information":[{"code":"CP17744631831397981","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338085503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Bimatoprost  Sol 0.03%","code_information":[{"code":"CP17744631828880844","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383091205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830066146","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457040913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Janumet      Tab 50-500mg","code_information":[{"code":"CP17744631830177914","type":"CDM"},{"code":"250","type":"RC"},{"code":"60575","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Janumet 50-500mg Tabs","code_information":[{"code":"CP17744631830176673","type":"CDM"},{"code":"250","type":"RC"},{"code":"60575","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Janumet Xr   Tab 100-1000","code_information":[{"code":"CP17744631830176810","type":"CDM"},{"code":"250","type":"RC"},{"code":"60081","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Janumet Xr 100-1000mg Tabs","code_information":[{"code":"CP17744631830178465","type":"CDM"},{"code":"250","type":"RC"},{"code":"60081","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Januvia      Tab 100mg","code_information":[{"code":"CP17744631830170915","type":"CDM"},{"code":"250","type":"RC"},{"code":"60277","type":"CPT","modifier":"54"}],"standard_charges":[{"setting":"outpatient","modifier_code":["54"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Januvia      Tab 50mg","code_information":[{"code":"CP17744631830185088","type":"CDM"},{"code":"250","type":"RC"},{"code":"60112","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Januvia 100mg Tabs","code_information":[{"code":"CP17744631830183498","type":"CDM"},{"code":"250","type":"RC"},{"code":"60277","type":"CPT","modifier":"54"}],"standard_charges":[{"setting":"outpatient","modifier_code":["54"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Januvia 50mg Tabs","code_information":[{"code":"CP17744631830186257","type":"CDM"},{"code":"250","type":"RC"},{"code":"60112","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nyamyc       Pow 100000","code_information":[{"code":"CP17744631830642203","type":"CDM"},{"code":"250","type":"RC"},{"code":"83204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Accu-check   Kit Guide Me","code_information":[{"code":"CP17744631828174090","type":"CDM"},{"code":"250","type":"RC"},{"code":"65702073110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Accu-chek    Kit Guide Me","code_information":[{"code":"CP17744631828172597","type":"CDM"},{"code":"250","type":"RC"},{"code":"65702073110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclopentol  Sol 2% Op","code_information":[{"code":"CP17744631829441262","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478009702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Refresh Cell Gel 1% Op","code_information":[{"code":"CP17744631830885579","type":"CDM"},{"code":"250","type":"RC"},{"code":"23455","type":"CPT","modifier":"430"}],"standard_charges":[{"setting":"outpatient","modifier_code":["430"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Apidra       Inj Solostar","code_information":[{"code":"CP17744631828723417","type":"CDM"},{"code":"250","type":"RC"},{"code":"88250","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Apidra Solo 100 Units/ml 3ml","code_information":[{"code":"CP17744631828722575","type":"CDM"},{"code":"250","type":"RC"},{"code":"88250","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Apidra Solostar 100unit/ml In","code_information":[{"code":"CP17744631828721895","type":"CDM"},{"code":"250","type":"RC"},{"code":"88250","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Hibiclens    Liq 4%","code_information":[{"code":"CP17744631830081290","type":"CDM"},{"code":"250","type":"RC"},{"code":"23405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Hibiclens    Sol 4%","code_information":[{"code":"CP17744631830087000","type":"CDM"},{"code":"250","type":"RC"},{"code":"23405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Hibiclens 4% Liqd","code_information":[{"code":"CP17744631830085130","type":"CDM"},{"code":"250","type":"RC"},{"code":"23405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830655199","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308015260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin 100000/gm Powder","code_information":[{"code":"CP17744631830653333","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308015260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Nystatin/zinc/triple_abx","code_information":[{"code":"CP17744631830659698","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308015260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti-em Knee Mis Leng Med","code_information":[{"code":"CP17744631828721921","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664011406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking Knee Hi Medium","code_information":[{"code":"CP17744631831071961","type":"CDM"},{"code":"250","type":"RC"},{"code":"35664011406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cequa        Sol 0.09%","code_information":[{"code":"CP17744631829191887","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335050696","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Blood Pressure Kit Manual","code_information":[{"code":"CP17744631828936927","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295012932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Futuro Ankle Mis Stabiliz","code_information":[{"code":"CP17744631830012304","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020151","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Almotriptan  Tab 12.5mg","code_information":[{"code":"CP17744631828427388","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241004221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Heparin Sod  Inj 5000/0.5","code_information":[{"code":"CP17744631830074089","type":"CDM"},{"code":"250","type":"RC"},{"code":"64162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Timolol Gel  Sol 0.25% Op","code_information":[{"code":"CP17744631831132536","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Douche Enema And Wtr Btl","code_information":[{"code":"CP17744631829721468","type":"CDM"},{"code":"250","type":"RC"},{"code":"3870310010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sitz Bath    Mis","code_information":[{"code":"CP17744631831021548","type":"CDM"},{"code":"250","type":"RC"},{"code":"8225262600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831093572","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335001183","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831099223","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241011303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831095048","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729037110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831094197","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241012302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831096676","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241011403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831098494","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729037210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rasagiline   Tab 0.5mg","code_information":[{"code":"CP17744631830870832","type":"CDM"},{"code":"250","type":"RC"},{"code":"37812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Silvercel 4.25x4.25","code_information":[{"code":"CP17744631831024299","type":"CDM"},{"code":"250","type":"RC"},{"code":"85633","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831097841","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300028813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831098870","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268073913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831091828","type":"CDM"},{"code":"250","type":"RC"},{"code":"35573041230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tadalafil    Tab 20mg","code_information":[{"code":"CP17744631831098897","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300028913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829838123","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877049005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Timoptic Ocu Sol 0.5% Op","code_information":[{"code":"CP17744631831133815","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208049968","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Levemir      Inj","code_information":[{"code":"CP17744631830298354","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levemir 100 Units/ml Mdv 10ml","code_information":[{"code":"CP17744631830296781","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Lacosamide   Tab 100mg","code_information":[{"code":"CP17744631830202812","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714054901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levemir      Inj Flextouc","code_information":[{"code":"CP17744631830291355","type":"CDM"},{"code":"250","type":"RC"},{"code":"16964","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levemir Flex 100iu/ml Soln","code_information":[{"code":"CP17744631830298579","type":"CDM"},{"code":"250","type":"RC"},{"code":"16964","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"F2"}},{"description":"Fluphenazine 25mg/ml Soln","code_information":[{"code":"CP17744631829975747","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023012901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Spritam      Tab 1000mg","code_information":[{"code":"CP17744631831063889","type":"CDM"},{"code":"250","type":"RC"},{"code":"43485010460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"T.e.d.       Mis Sm/reg","code_information":[{"code":"CP17744631831092255","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080426500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tadalafil    Tab 10mg","code_information":[{"code":"CP17744631831097344","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547005003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olopatadine  Sol 0.2%","code_information":[{"code":"CP17744631830673453","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478030512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Olopatadine  Sol 0.2%","code_information":[{"code":"CP17744631830676603","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505058604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Prednisolone Tab 5mg","code_information":[{"code":"CP17744631830818075","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651049101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Restasis     Emu 0.05%","code_information":[{"code":"CP17744631830893515","type":"CDM"},{"code":"250","type":"RC"},{"code":"23916","type":"CPT","modifier":"330"}],"standard_charges":[{"setting":"outpatient","modifier_code":["330"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Restasis     Emu 0.05%","code_information":[{"code":"CP17744631830890821","type":"CDM"},{"code":"250","type":"RC"},{"code":"23916","type":"CPT","modifier":"360"}],"standard_charges":[{"setting":"outpatient","modifier_code":["360"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Restasis     Emu 0.05% Op","code_information":[{"code":"CP17744631830897655","type":"CDM"},{"code":"250","type":"RC"},{"code":"23916","type":"CPT","modifier":"360"}],"standard_charges":[{"setting":"outpatient","modifier_code":["360"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Restasis     Emu 0.05% Op","code_information":[{"code":"CP17744631830892360","type":"CDM"},{"code":"250","type":"RC"},{"code":"23916","type":"CPT","modifier":"330"}],"standard_charges":[{"setting":"outpatient","modifier_code":["330"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Restasis 0.05% Emul","code_information":[{"code":"CP17744631830897799","type":"CDM"},{"code":"250","type":"RC"},{"code":"23916","type":"CPT","modifier":"360"}],"standard_charges":[{"setting":"outpatient","modifier_code":["360"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mirabegron   Tab 50mg Er","code_information":[{"code":"CP17744631830492933","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710116009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Brom/pse/dm  Syp","code_information":[{"code":"CP17744631828959822","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192060704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Brom/pse/dm  Syp 2/30/10","code_information":[{"code":"CP17744631828953044","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192060704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Systane Ultr Sol","code_information":[{"code":"CP17744631831090742","type":"CDM"},{"code":"250","type":"RC"},{"code":"65143","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Almotriptan  Tab 6.25mg","code_information":[{"code":"CP17744631828420875","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241004111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Carboxmethyl Gel 1% Op","code_information":[{"code":"CP17744631829121217","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268006615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Disulfiram   Tab 250mg","code_information":[{"code":"CP17744631829718472","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135043190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Livalo       Tab 1mg","code_information":[{"code":"CP17744631830352677","type":"CDM"},{"code":"250","type":"RC"},{"code":"66869010490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Livalo       Tab 2mg","code_information":[{"code":"CP17744631830358533","type":"CDM"},{"code":"250","type":"RC"},{"code":"66869020490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Livalo       Tab 4mg","code_information":[{"code":"CP17744631830359941","type":"CDM"},{"code":"250","type":"RC"},{"code":"66869040490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Etravirine   Tab 200mg","code_information":[{"code":"CP17744631829823429","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315028606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Epinephrine  Inj 1mg/ml","code_information":[{"code":"CP17744631829796777","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Epinephrine 1mg/ml Amp Soln","code_information":[{"code":"CP17744631829794834","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fulvestrant  Inj 250/5ml","code_information":[{"code":"CP17744631830002554","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860021174","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Gralise      Tab 300mg","code_information":[{"code":"CP17744631830056861","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427080390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Gralise      Tab 600mg","code_information":[{"code":"CP17744631830056404","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427080690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Zenpep       Cap 25000","code_information":[{"code":"CP17744631831397267","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":25000,"type":"EA"}},{"description":"Zenpep       Cap 25000unt","code_information":[{"code":"CP17744631831396109","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":25000,"type":"EA"}},{"description":"Zenpep 25000","code_information":[{"code":"CP17744631831390711","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aloglip/metfor 12.5/1000mg Tab","code_information":[{"code":"CP17744631828430247","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802021172","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Alogliptin/  Tab Metform","code_information":[{"code":"CP17744631828438936","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802021172","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humalog Jr   Inj 100/ml","code_information":[{"code":"CP17744631830085095","type":"CDM"},{"code":"250","type":"RC"},{"code":"27714","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humalog Jr 100 Units/ml Kwpen","code_information":[{"code":"CP17744631830082060","type":"CDM"},{"code":"250","type":"RC"},{"code":"27714","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Humalog Mix  Inj 50/50kwp","code_information":[{"code":"CP17744631830089467","type":"CDM"},{"code":"250","type":"RC"},{"code":"28798","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Humalog Mix  Inj 75/25kwp","code_information":[{"code":"CP17744631830088150","type":"CDM"},{"code":"250","type":"RC"},{"code":"28797","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Humalog Mix 50/50 Kwikpen","code_information":[{"code":"CP17744631830087596","type":"CDM"},{"code":"250","type":"RC"},{"code":"28798","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Humalog Mix 50/50 Kwikpen 3ml","code_information":[{"code":"CP17744631830088576","type":"CDM"},{"code":"250","type":"RC"},{"code":"28798","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Humalog Mix 75/25 Kwikpen","code_information":[{"code":"CP17744631830088392","type":"CDM"},{"code":"250","type":"RC"},{"code":"28797","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Humalog Mix 75/25 Kwikpen 3ml","code_information":[{"code":"CP17744631830083322","type":"CDM"},{"code":"250","type":"RC"},{"code":"28797","type":"CPT","modifier":"59"}],"standard_charges":[{"setting":"outpatient","modifier_code":["59"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Humalog Tmpo Inj 100/ml","code_information":[{"code":"CP17744631830080771","type":"CDM"},{"code":"250","type":"RC"},{"code":"28213","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Cipro/dexa   Sus 0.3-0.1%","code_information":[{"code":"CP17744631829234968","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Iyuzeh       Dro 0.005%","code_information":[{"code":"CP17744631830179382","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584000330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Santyl       Oin 250/gm","code_information":[{"code":"CP17744631830997753","type":"CDM"},{"code":"250","type":"RC"},{"code":"50484001090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Naloxone     Spr 4mg","code_information":[{"code":"CP17744631830537562","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Perforomist  Neb 20mcg","code_information":[{"code":"CP17744631830752168","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502060530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Perforomist  Neb 20mcg","code_information":[{"code":"CP17744631830759192","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502060561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Perforomist 20mcg/2ml Nebu","code_information":[{"code":"CP17744631830754921","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502060530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Perforomist 20mcg/2ml Nebu","code_information":[{"code":"CP17744631830751112","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502060561","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Timolol Male Sol 0.5%","code_information":[{"code":"CP17744631831137446","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682004550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Timolol Male Sol 0.5%","code_information":[{"code":"CP17744631831133744","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682004525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828791986","type":"CDM"},{"code":"250","type":"RC"},{"code":"76478001505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epifoam      Aer 1%","code_information":[{"code":"CP17744631829796919","type":"CDM"},{"code":"250","type":"RC"},{"code":"37682","type":"CPT","modifier":"410"}],"standard_charges":[{"setting":"outpatient","modifier_code":["410"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Emtr/ten Df  Tab 100-150","code_information":[{"code":"CP17744631829774543","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238209203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Emtr/tenofov Tab 200-300","code_information":[{"code":"CP17744631829773130","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385095330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Emtr/tenofov Tab 200-300","code_information":[{"code":"CP17744631829778235","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714053401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Emtr/tenofov Tab 200-300","code_information":[{"code":"CP17744631829774721","type":"CDM"},{"code":"250","type":"RC"},{"code":"37819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Emtr/tenofov Tab 200-300","code_information":[{"code":"CP17744631829770559","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710136703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Emtr/tenofov Tab 200-300","code_information":[{"code":"CP17744631829770954","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097074102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Emtr/tenofov Tab 200-300","code_information":[{"code":"CP17744631829772613","type":"CDM"},{"code":"250","type":"RC"},{"code":"93770","type":"CPT","modifier":"456"}],"standard_charges":[{"setting":"outpatient","modifier_code":["456"],"minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Emtr/tenofov Tab 200-300","code_information":[{"code":"CP17744631829770420","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862035430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Emtricitabine-tenofv 200-300mg","code_information":[{"code":"CP17744631829774418","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862035430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Octreotide   Inj 500mcg","code_information":[{"code":"CP17744631830659188","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155068941","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":9,"maximum":11,"gross_charge":11,"discounted_cash":11,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":11},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diovan       Tab 160mg","code_information":[{"code":"CP17744631829708180","type":"CDM"},{"code":"250","type":"RC"},{"code":"78035","type":"CPT","modifier":"934"}],"standard_charges":[{"setting":"outpatient","modifier_code":["934"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Tybost       Tab 150mg","code_information":[{"code":"CP17744631831208903","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958140101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Methylphenid Tab 27mg Er","code_information":[{"code":"CP17744631830455411","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037073401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":27,"type":"ME"}},{"description":"Corlanor     Tab 5mg","code_information":[{"code":"CP17744631829421787","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513080060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Corlanor     Tab 7.5mg","code_information":[{"code":"CP17744631829421178","type":"CDM"},{"code":"250","type":"RC"},{"code":"55513081060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Prednisolone Tab 15mg Odt","code_information":[{"code":"CP17744631830815818","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993084535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Solu-medrol  Inj 125mg","code_information":[{"code":"CP17744631831054167","type":"CDM"},{"code":"250","type":"RC"},{"code":"90047","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Solumedrol 125mg/100ml Ns","code_information":[{"code":"CP17744631831054045","type":"CDM"},{"code":"250","type":"RC"},{"code":"90047","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Kristalose   Pak 20gm","code_information":[{"code":"CP17744631830199054","type":"CDM"},{"code":"250","type":"RC"},{"code":"66220072930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":20,"type":"GR"}},{"description":"Tobra/dexame Sus 0.3-0.1%","code_information":[{"code":"CP17744631831141766","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Keppra       Tab 500mg","code_information":[{"code":"CP17744631830185991","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474059540","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Keppra 500mg Tabs","code_information":[{"code":"CP17744631830188951","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474059540","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Diazepam     Inj 5mg/ml","code_information":[{"code":"CP17744631829581891","type":"CDM"},{"code":"250","type":"RC"},{"code":"69339013632","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sirolimus    Tab 1mg","code_information":[{"code":"CP17744631831024153","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382035101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tegaderm 4x4.75\" Dressing Pads","code_information":[{"code":"CP17744631831106049","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333906010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pramipexole  Tab 3.75 Er","code_information":[{"code":"CP17744631830806926","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370030611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Ace Ankle Brace Adjust","code_information":[{"code":"CP17744631828182417","type":"CDM"},{"code":"250","type":"RC"},{"code":"5113120387","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac Sod 1% Gel","code_information":[{"code":"CP17744631829591004","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122064654","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Goodsense    Gel Art Pain","code_information":[{"code":"CP17744631830054947","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122064654","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Accrufer     Cap 30mg","code_information":[{"code":"CP17744631828179623","type":"CDM"},{"code":"250","type":"RC"},{"code":"73059000160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828790298","type":"CDM"},{"code":"250","type":"RC"},{"code":"65081","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Budesonide   Tab Er 9mg","code_information":[{"code":"CP17744631828963426","type":"CDM"},{"code":"250","type":"RC"},{"code":"59125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Piper/tazoba Inj 4-0.5gm","code_information":[{"code":"CP17744631830787894","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Sucralfate   Sus 1gm/10ml","code_information":[{"code":"CP17744631831072554","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689030516","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Valganciclov Tab 450mg","code_information":[{"code":"CP17744631831227274","type":"CDM"},{"code":"250","type":"RC"},{"code":"60363","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Valganciclov Tab 450mg","code_information":[{"code":"CP17744631831229822","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862075360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Valganciclov Tab 450mg","code_information":[{"code":"CP17744631831222711","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380015301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Soaanz       Tab 40mg","code_information":[{"code":"CP17744631831038957","type":"CDM"},{"code":"250","type":"RC"},{"code":"73502058610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Soaanz (Torsemide) 40mg-tabs","code_information":[{"code":"CP17744631831037107","type":"CDM"},{"code":"250","type":"RC"},{"code":"73502058610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Foltanx Rf   Cap","code_information":[{"code":"CP17744631829996875","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991091390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Optifoam Wound Dress 6x6","code_information":[{"code":"CP17744631830695256","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327045027","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexilant     Cap 30mg Dr","code_information":[{"code":"CP17744631829575934","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764017130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Dexilant     Cap 60mg Dr","code_information":[{"code":"CP17744631829573899","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764017530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dexilant     Cap 60mg Dr","code_information":[{"code":"CP17744631829573226","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764017590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dexilant 30mg Caps","code_information":[{"code":"CP17744631829570674","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764017130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Dexilant 60mg Caps","code_information":[{"code":"CP17744631829574199","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764017590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Androderm    Dis 2mg/24hr","code_information":[{"code":"CP17744631828530885","type":"CDM"},{"code":"250","type":"RC"},{"code":"23599","type":"CPT","modifier":"60"}],"standard_charges":[{"setting":"outpatient","modifier_code":["60"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pulmicort    Sus 1mg/2ml","code_information":[{"code":"CP17744631830855518","type":"CDM"},{"code":"250","type":"RC"},{"code":"18619","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Pulmicort 1mg/2ml Inhalation","code_information":[{"code":"CP17744631830850060","type":"CDM"},{"code":"250","type":"RC"},{"code":"18619","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Methylpr Ace Inj 400/5ml","code_information":[{"code":"CP17744631830456389","type":"CDM"},{"code":"250","type":"RC"},{"code":"78135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830657778","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Knee Support Mis Moderate","code_information":[{"code":"CP17744631830195659","type":"CDM"},{"code":"250","type":"RC"},{"code":"74676064411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sertraline   Cap 150mg","code_information":[{"code":"CP17744631831007633","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427066430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Theo-24      Cap 400mg Er","code_information":[{"code":"CP17744631831129140","type":"CDM"},{"code":"250","type":"RC"},{"code":"52244040010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Ergot/caffen Tab 1-100mg","code_information":[{"code":"CP17744631829791789","type":"CDM"},{"code":"250","type":"RC"},{"code":"24470091710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Doxepin      Tab 6mg","code_information":[{"code":"CP17744631829738707","type":"CDM"},{"code":"250","type":"RC"},{"code":"72819016203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830539749","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478004101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Naloxone 0.4mg/ml Inj","code_information":[{"code":"CP17744631830533507","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478004101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Xarelto      Tab 2.5mg","code_information":[{"code":"CP17744631831384464","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Microchamber Mis","code_information":[{"code":"CP17744631830485815","type":"CDM"},{"code":"250","type":"RC"},{"code":"47360017202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830158735","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/dex Oin 0.1% Op","code_information":[{"code":"CP17744631830541042","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Digoxin      Tab 0.0625mg","code_information":[{"code":"CP17744631829609429","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954020010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Futuro Anti- Mis Em Thigh","code_information":[{"code":"CP17744631830017873","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020167","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Brovana      Neb 15mcg","code_information":[{"code":"CP17744631828952741","type":"CDM"},{"code":"250","type":"RC"},{"code":"27437006030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Cyclosporine Cap 100mg","code_information":[{"code":"CP17744631829445333","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505013400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dorzol/timol Sol 2-0.5%op","code_information":[{"code":"CP17744631829728712","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829728752","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Dorzolamide/timolol Ophth","code_information":[{"code":"CP17744631829729934","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lyrica       Cap 100mg","code_information":[{"code":"CP17744631830381480","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"568"}],"standard_charges":[{"setting":"outpatient","modifier_code":["568"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lyrica       Cap 150mg","code_information":[{"code":"CP17744631830389676","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"668"}],"standard_charges":[{"setting":"outpatient","modifier_code":["668"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lyrica       Cap 300mg","code_information":[{"code":"CP17744631830390064","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"868"}],"standard_charges":[{"setting":"outpatient","modifier_code":["868"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lyrica       Cap 50mg","code_information":[{"code":"CP17744631830390967","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"368"}],"standard_charges":[{"setting":"outpatient","modifier_code":["368"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lyrica       Cap 75mg","code_information":[{"code":"CP17744631830397139","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"468"}],"standard_charges":[{"setting":"outpatient","modifier_code":["468"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Lyrica 100mg Caps","code_information":[{"code":"CP17744631830390067","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"568"}],"standard_charges":[{"setting":"outpatient","modifier_code":["568"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lyrica 150mg Caps","code_information":[{"code":"CP17744631830395475","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"668"}],"standard_charges":[{"setting":"outpatient","modifier_code":["668"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lyrica 25mg Caps","code_information":[{"code":"CP17744631830391598","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"268"}],"standard_charges":[{"setting":"outpatient","modifier_code":["268"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lyrica 50mg Caps","code_information":[{"code":"CP17744631830392341","type":"CDM"},{"code":"250","type":"RC"},{"code":"71101","type":"CPT","modifier":"368"}],"standard_charges":[{"setting":"outpatient","modifier_code":["368"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830662350","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383002505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 25mcg/hr","code_information":[{"code":"CP17744631829852215","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Droxidopa    Cap 200mg","code_information":[{"code":"CP17744631829750070","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241020090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Surgilast Size 4","code_information":[{"code":"CP17744631831089960","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"704","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":10,"discounted_cash":10}]},{"description":"Imiquimod    Cre 5%","code_information":[{"code":"CP17744631830132801","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802036853","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Knee High 30-40-large","code_information":[{"code":"CP17744631830199630","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189060188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830765753","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097099902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830766428","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710101401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830763987","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710101403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Stocking K-h Large 30-40","code_information":[{"code":"CP17744631831067591","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking K-h Medium 30-40","code_information":[{"code":"CP17744631831060800","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960187","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking Knee High 30-40","code_information":[{"code":"CP17744631831075676","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189060188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kristalose   Pak 10gm","code_information":[{"code":"CP17744631830199415","type":"CDM"},{"code":"250","type":"RC"},{"code":"66220071930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Activella    Tab 1-0.5mg","code_information":[{"code":"CP17744631828321779","type":"CDM"},{"code":"250","type":"RC"},{"code":"60846023201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dalfampridin Tab 10mg Er","code_information":[{"code":"CP17744631829471786","type":"CDM"},{"code":"250","type":"RC"},{"code":"59125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Celebrex     Cap 100mg","code_information":[{"code":"CP17744631829188883","type":"CDM"},{"code":"250","type":"RC"},{"code":"25152","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Brinzolamide Sus 1%","code_information":[{"code":"CP17744631828952530","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682046415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cane Tour/hndl Adj Blk","code_information":[{"code":"CP17744631829101666","type":"CDM"},{"code":"250","type":"RC"},{"code":"3870303002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Delivery Fee/stop Fee","code_information":[{"code":"CP17744631829551224","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999154627","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac   Gel 1%","code_information":[{"code":"CP17744631829595357","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598097710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gatifloxacin Sol 0.5%","code_information":[{"code":"CP17744631830021834","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314067225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Meropenem    Inj 1gm","code_information":[{"code":"CP17744631830429852","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem    Inj 1gm","code_information":[{"code":"CP17744631830422564","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121145307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem    Inj 1gm","code_information":[{"code":"CP17744631830423912","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem    Inj 1gm","code_information":[{"code":"CP17744631830421666","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323050831","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem    Inj 500mg","code_information":[{"code":"CP17744631830429125","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 1 Gm In 100 Ml Ns","code_information":[{"code":"CP17744631830422130","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1 Gm/100 Ml Ns","code_information":[{"code":"CP17744631830426504","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1gm/100ml Ns","code_information":[{"code":"CP17744631830426867","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 2g In 100ml Ns","code_information":[{"code":"CP17744631830423192","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 2g/100ml Ns","code_information":[{"code":"CP17744631830423834","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Meropenem 500mg/100ml Elj","code_information":[{"code":"CP17744631830427227","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 500mg/100ml Ns","code_information":[{"code":"CP17744631830429734","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 500mg/50ml Ns","code_information":[{"code":"CP17744631830429298","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 500mg/50ml Ns Mb","code_information":[{"code":"CP17744631830421801","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 500mg/50ml Ns Mb+","code_information":[{"code":"CP17744631830425289","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830495151","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332038690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830491028","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155060503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Podofilox    Sol 0.5%","code_information":[{"code":"CP17744631830789641","type":"CDM"},{"code":"250","type":"RC"},{"code":"57406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831112377","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536062501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Timolol Gel  Sol 0.25% Op","code_information":[{"code":"CP17744631831134104","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Tobra/dexame Sus 0.3-0.1%","code_information":[{"code":"CP17744631831140745","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Tobramycin/dex 0.3%-0.1% Susp","code_information":[{"code":"CP17744631831146140","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Ultratrak Complete Device","code_information":[{"code":"CP17744631831207354","type":"CDM"},{"code":"250","type":"RC"},{"code":"38593000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xigduo Xr    Tab 2.5-1000","code_information":[{"code":"CP17744631831387728","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Xigduo Xr    Tab 5-1000mg","code_information":[{"code":"CP17744631831389239","type":"CDM"},{"code":"250","type":"RC"},{"code":"31062","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Indocin      Sus 25mg/5ml","code_information":[{"code":"CP17744631830132975","type":"CDM"},{"code":"250","type":"RC"},{"code":"69344010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829721858","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Invokamet    Tab 150-1000","code_information":[{"code":"CP17744631830156233","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458054360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Invokamet    Tab 50-1000","code_information":[{"code":"CP17744631830152219","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458054160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Invokamet    Tab 50-500mg","code_information":[{"code":"CP17744631830157318","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458054060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Invokamet Xr Tab 150-1000","code_information":[{"code":"CP17744631830150942","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458094301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Invokamet Xr Tab 50-1000","code_information":[{"code":"CP17744631830153015","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458094101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Invokamet Xr Tab 50-500mg","code_information":[{"code":"CP17744631830158065","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458094001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Angel Paste","code_information":[{"code":"CP17744631828534153","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Elidel       Cre 1%","code_information":[{"code":"CP17744631829775473","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Elidel       Cre 1%","code_information":[{"code":"CP17744631829773390","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Impoyz       Cre 0.025%","code_information":[{"code":"CP17744631830131019","type":"CDM"},{"code":"250","type":"RC"},{"code":"69482070099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Sildenafil   Tab 100mg","code_information":[{"code":"CP17744631831019377","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sildenafil   Tab 100mg","code_information":[{"code":"CP17744631831014384","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219175303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sildenafil   Tab 100mg","code_information":[{"code":"CP17744631831010522","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722071130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sildenafil   Tab 100mg","code_information":[{"code":"CP17744631831011980","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748013306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sildenafil   Tab 100mg","code_information":[{"code":"CP17744631831019205","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817034230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sildenafil   Tab 25mg","code_information":[{"code":"CP17744631831010608","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817034030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sildenafil   Tab 25mg","code_information":[{"code":"CP17744631831012274","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862068930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sildenafil   Tab 25mg","code_information":[{"code":"CP17744631831016550","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219175103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831013210","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831014545","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762003501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831015038","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831013192","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342004211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831011854","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722071030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831017289","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219175203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831018415","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817034130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Silver Sulfa Cre 1%","code_information":[{"code":"CP17744631831022736","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Silver Sulfadiazine-1%-crea","code_information":[{"code":"CP17744631831021729","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Silver Sulfs Crm / Zinc Oxide","code_information":[{"code":"CP17744631831025751","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ssd/lidocaine5%/vaseline","code_information":[{"code":"CP17744631831067723","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877012405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacrisert    Mis 5mg Op","code_information":[{"code":"CP17744631830202202","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208080060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Knee High 20-30 X-lge","code_information":[{"code":"CP17744631830198173","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189060168","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylpr Ace Inj 80mg/ml","code_information":[{"code":"CP17744631830457472","type":"CDM"},{"code":"250","type":"RC"},{"code":"70300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Stocking K-h Xl 20-30","code_information":[{"code":"CP17744631831079548","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189060168","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valganciclov Tab 450mg","code_information":[{"code":"CP17744631831220910","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Heparin Sod  Inj 5000/0.5","code_information":[{"code":"CP17744631830079065","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323054313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Brinzolamide Sus 1%","code_information":[{"code":"CP17744631828953983","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682046410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Celexa       Tab 40mg","code_information":[{"code":"CP17744631829190886","type":"CDM"},{"code":"250","type":"RC"},{"code":"45640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Dicontinued","code_information":[{"code":"CP17744631829590104","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502019675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Discontinued Please Use Alt","code_information":[{"code":"CP17744631829708106","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502019675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Myorisan     Cap 30mg","code_information":[{"code":"CP17744631830534365","type":"CDM"},{"code":"250","type":"RC"},{"code":"61748030313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Semglee      Inj 100u/ml","code_information":[{"code":"CP17744631831005627","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502019675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Semglee      Sol 100u/ml","code_information":[{"code":"CP17744631831001567","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502019580","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Semglee Inj 100u/ml Pen","code_information":[{"code":"CP17744631831008489","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502019675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Stocking K-h Xl 20-30 Ot","code_information":[{"code":"CP17744631831077778","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wrist Thumb Supp Medium","code_information":[{"code":"CP17744631831383889","type":"CDM"},{"code":"250","type":"RC"},{"code":"86921957222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Depo-medrol  Inj 40mg/ml","code_information":[{"code":"CP17744631829558387","type":"CDM"},{"code":"250","type":"RC"},{"code":"90280","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ipratrop/albut 0.5-3mg/3ml Sol","code_information":[{"code":"CP17744631830150879","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097017353","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830150705","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097017353","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alocane Burn Gel 4%","code_information":[{"code":"CP17744631828430232","type":"CDM"},{"code":"250","type":"RC"},{"code":"68229020102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Brovana      Neb 15mcg","code_information":[{"code":"CP17744631828959744","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402091164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Brovana      Neb 15mcg","code_information":[{"code":"CP17744631828959849","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402091130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Brovana 15mcg/2ml Inhalation","code_information":[{"code":"CP17744631828950233","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402091130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Brovana 15mcg/2ml Nebu","code_information":[{"code":"CP17744631828954920","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402091164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Armodafinil  Tab 250mg","code_information":[{"code":"CP17744631828751149","type":"CDM"},{"code":"250","type":"RC"},{"code":"37834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830158236","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204060030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Admelog      Inj 100u/ml","code_information":[{"code":"CP17744631828358512","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"410"}],"standard_charges":[{"setting":"outpatient","modifier_code":["410"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Admelog 100 Unit/ml Mdv 10ml","code_information":[{"code":"CP17744631828350406","type":"CDM"},{"code":"250","type":"RC"},{"code":"24592","type":"CPT","modifier":"410"}],"standard_charges":[{"setting":"outpatient","modifier_code":["410"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Elastomeric Pump200/400ml","code_information":[{"code":"CP17744631829765748","type":"CDM"},{"code":"250","type":"RC"},{"code":"2004000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":400,"type":"ML"}},{"description":"Stocking K-h Small 8-15","code_information":[{"code":"CP17744631831073456","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566411402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking Knee Hi Regular","code_information":[{"code":"CP17744631831077236","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566411402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xanax        Tab 1mg","code_information":[{"code":"CP17744631831380347","type":"CDM"},{"code":"250","type":"RC"},{"code":"90090","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aspercreme   Cre 10%","code_information":[{"code":"CP17744631828765528","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167005724","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Valium       Tab 2mg","code_information":[{"code":"CP17744631831228233","type":"CDM"},{"code":"250","type":"RC"},{"code":"80725000401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aquaphor     Oin","code_information":[{"code":"CP17744631828730377","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140003263","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aquaphor Oint (99g)","code_information":[{"code":"CP17744631828734891","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140003263","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":99,"type":"GR"}},{"description":"Diovan 80mg Tabs","code_information":[{"code":"CP17744631829703629","type":"CDM"},{"code":"250","type":"RC"},{"code":"78035","type":"CPT","modifier":"834"}],"standard_charges":[{"setting":"outpatient","modifier_code":["834"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Refresh Lacr Oin Op","code_information":[{"code":"CP17744631830885592","type":"CDM"},{"code":"250","type":"RC"},{"code":"23031","type":"CPT","modifier":"204"}],"standard_charges":[{"setting":"outpatient","modifier_code":["204"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Preparation  Cre H","code_information":[{"code":"CP17744631830826150","type":"CDM"},{"code":"250","type":"RC"},{"code":"57328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Promethegan  Sup 12.5mg","code_information":[{"code":"CP17744631830849712","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Promethegan  Sup 25mg","code_information":[{"code":"CP17744631830840735","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Synjardy Xr  Tab 5-1000mg","code_information":[{"code":"CP17744631831082473","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Flomax       Cap 0.4mg","code_information":[{"code":"CP17744631829965959","type":"CDM"},{"code":"250","type":"RC"},{"code":"24583","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Insulin Glar Sol 100u/ml","code_information":[{"code":"CP17744631830148206","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glargine 100 Un/ml Mdv","code_information":[{"code":"CP17744631830147180","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Cefazolin 50mg/ml Ophth Sol","code_information":[{"code":"CP17744631829157278","type":"CDM"},{"code":"250","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Aripiprazole Tab 15mg Odt","code_information":[{"code":"CP17744631828749523","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598073430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Budesonide   Tab Er 9mg","code_information":[{"code":"CP17744631828969879","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682030930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831018810","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834024001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Haloperidol  Con 2mg/ml","code_information":[{"code":"CP17744631830063700","type":"CDM"},{"code":"250","type":"RC"},{"code":"54838050115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Toviaz       Tab 4mg","code_information":[{"code":"CP17744631831157789","type":"CDM"},{"code":"250","type":"RC"},{"code":"69024","type":"CPT","modifier":"230"}],"standard_charges":[{"setting":"outpatient","modifier_code":["230"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Valganciclov Tab 450mg","code_information":[{"code":"CP17744631831227478","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722083260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831256619","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714003801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Alka-seltz Lemon/lime 36","code_information":[{"code":"CP17744631828416658","type":"CDM"},{"code":"250","type":"RC"},{"code":"28040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anucort-hc   Sup 25mg","code_information":[{"code":"CP17744631828725962","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mesalamine   Tab 1.2gm","code_information":[{"code":"CP17744631830437613","type":"CDM"},{"code":"250","type":"RC"},{"code":"52730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Lumify       Dro 0.025%","code_information":[{"code":"CP17744631830385355","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208053708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nexium       Gra 10mg Dr","code_information":[{"code":"CP17744631830554790","type":"CDM"},{"code":"250","type":"RC"},{"code":"18640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nexium       Gra 20mg Dr","code_information":[{"code":"CP17744631830553145","type":"CDM"},{"code":"250","type":"RC"},{"code":"18640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nexium       Gra 40mg Dr","code_information":[{"code":"CP17744631830558651","type":"CDM"},{"code":"250","type":"RC"},{"code":"18640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nexium       Gra 5mg Dr","code_information":[{"code":"CP17744631830555618","type":"CDM"},{"code":"250","type":"RC"},{"code":"18640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dymista      Spr 137-50","code_information":[{"code":"CP17744631829764165","type":"CDM"},{"code":"250","type":"RC"},{"code":"37024","type":"CPT","modifier":"523"}],"standard_charges":[{"setting":"outpatient","modifier_code":["523"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":137,"type":"EA"}},{"description":"Eliquis      Tab 5mg","code_information":[{"code":"CP17744631829772704","type":"CDM"},{"code":"250","type":"RC"},{"code":"30894","type":"CPT","modifier":"70"}],"standard_charges":[{"setting":"outpatient","modifier_code":["70"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxtellar Xr  Tab 150mg","code_information":[{"code":"CP17744631830706604","type":"CDM"},{"code":"250","type":"RC"},{"code":"17772012101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Wheelchairs Seat Belt","code_information":[{"code":"CP17744631831379637","type":"CDM"},{"code":"250","type":"RC"},{"code":"57770100000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Collagen Dressing","code_information":[{"code":"CP17744631829403262","type":"CDM"},{"code":"250","type":"RC"},{"code":"20612479817","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pyridostigmi Tab Er 180mg","code_information":[{"code":"CP17744631830855895","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980022003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Caneadjustable","code_information":[{"code":"CP17744631829102972","type":"CDM"},{"code":"250","type":"RC"},{"code":"56666660100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kenalog-40   Inj 40mg/ml","code_information":[{"code":"CP17744631830187448","type":"CDM"},{"code":"250","type":"RC"},{"code":"30293","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Meloxicam    Cap 10mg","code_information":[{"code":"CP17744631830410568","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180018906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Meloxicam    Cap 5mg","code_information":[{"code":"CP17744631830413689","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180018806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":8,"maximum":10,"gross_charge":10,"discounted_cash":10,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":10},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830870588","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine Er 1000mg Tabs","code_information":[{"code":"CP17744631830876241","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Celexa       Tab 20mg","code_information":[{"code":"CP17744631829193484","type":"CDM"},{"code":"250","type":"RC"},{"code":"45640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Prasugrel 10mg Tabs","code_information":[{"code":"CP17744631830801058","type":"CDM"},{"code":"250","type":"RC"},{"code":"37851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amld/vals/hctz 10-320-25mg Tab","code_information":[{"code":"CP17744631828470333","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380020101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/valsar Tab /Hctz","code_information":[{"code":"CP17744631828480193","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380020101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod-valsa-hct 10-320-25mg Tb","code_information":[{"code":"CP17744631828497250","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380020101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aquacel Ag   Pad 2\"x2\"","code_information":[{"code":"CP17744631828735998","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012559","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketoconazole Cre 2%","code_information":[{"code":"CP17744631830181791","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714095501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830539617","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830652656","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308015215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Linzess      Cap 290mcg","code_information":[{"code":"CP17744631830347550","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":29,"type":"ME"}},{"description":"Linzess 290mcg Caps","code_information":[{"code":"CP17744631830342294","type":"CDM"},{"code":"250","type":"RC"},{"code":"45612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":29,"type":"ME"}},{"description":"Silodosin    Cap 8mg","code_information":[{"code":"CP17744631831010033","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651009630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Silodosin    Cap 8mg","code_information":[{"code":"CP17744631831016559","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651009690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Apraclonidin Sol 0.5% Op","code_information":[{"code":"CP17744631828730375","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Haloper Dec  Inj 500/5ml","code_information":[{"code":"CP17744631830064301","type":"CDM"},{"code":"250","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Keppra Xr    Tab 500mg","code_information":[{"code":"CP17744631830188601","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474059866","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Asacol Hd    Tab 800mg","code_information":[{"code":"CP17744631828755878","type":"CDM"},{"code":"250","type":"RC"},{"code":"23590","type":"CPT","modifier":"118"}],"standard_charges":[{"setting":"outpatient","modifier_code":["118"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Demeclocycl  Tab 300mg","code_information":[{"code":"CP17744631829553921","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746055548","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830921876","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808015603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Kenalog-40   Inj 40mg/ml","code_information":[{"code":"CP17744631830181326","type":"CDM"},{"code":"250","type":"RC"},{"code":"30293","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lialda       Tab 1.2gm","code_information":[{"code":"CP17744631830323939","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092047612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Lialda 1.2gm Tabs","code_information":[{"code":"CP17744631830323032","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092047612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Cymbalta     Cap 30mg","code_information":[{"code":"CP17744631829443748","type":"CDM"},{"code":"250","type":"RC"},{"code":"23240","type":"CPT","modifier":"90"}],"standard_charges":[{"setting":"outpatient","modifier_code":["90"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cymbalta     Cap 30mg","code_information":[{"code":"CP17744631829449169","type":"CDM"},{"code":"250","type":"RC"},{"code":"23240","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cymbalta     Cap 60mg","code_information":[{"code":"CP17744631829449827","type":"CDM"},{"code":"250","type":"RC"},{"code":"23270","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Budesonide   Cap 3mg Dr","code_information":[{"code":"CP17744631828959767","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714082901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Terconazole  Sup 80mg","code_information":[{"code":"CP17744631831119554","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802071708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ankle Brace Lace-up F8","code_information":[{"code":"CP17744631828536270","type":"CDM"},{"code":"250","type":"RC"},{"code":"71986953969","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Futuro Neck Collar","code_information":[{"code":"CP17744631830014935","type":"CDM"},{"code":"250","type":"RC"},{"code":"5113120136","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Budesonide   Aer 2mg/act","code_information":[{"code":"CP17744631828954964","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802062786","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Fiasp 100 Unit/ml Flexpen 3ml","code_information":[{"code":"CP17744631829947643","type":"CDM"},{"code":"250","type":"RC"},{"code":"16932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Fiasp Flex   Inj Touch","code_information":[{"code":"CP17744631829947224","type":"CDM"},{"code":"250","type":"RC"},{"code":"16932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Arnuity Ellipta 200mcg (30inh)","code_information":[{"code":"CP17744631828757319","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Arnuity Ellipta 200mcg Inhaler","code_information":[{"code":"CP17744631828759347","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Arnuity Elpt Inh 200mcg","code_information":[{"code":"CP17744631828757318","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Olanzapine    Tab 10mg Odt","code_information":[{"code":"CP17744631830660928","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 10mg Odt","code_information":[{"code":"CP17744631830666180","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine Odt 10mg Tabs","code_information":[{"code":"CP17744631830670330","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Risedronate  Tab 35mg","code_information":[{"code":"CP17744631830896607","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335066868","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Risedronate  Tab 35mg","code_information":[{"code":"CP17744631830897319","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342010937","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Risedronate  Tab 35mg","code_information":[{"code":"CP17744631830897651","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505316500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Risedronate  Tab 35mg","code_information":[{"code":"CP17744631830890975","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342010950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Synjardy     Tab 5-500mg","code_information":[{"code":"CP17744631831083043","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Synjardy     Tab 5-500mg","code_information":[{"code":"CP17744631831082609","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829239669","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436000804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ciprofloxacin 100mg Tabs","code_information":[{"code":"CP17744631829238405","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111012506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ciprofloxacn Tab 100mg","code_information":[{"code":"CP17744631829240460","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111012506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Oxycontin    Tab 15mg Cr","code_information":[{"code":"CP17744631830710089","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxycontin    Tab 15mg Er","code_information":[{"code":"CP17744631830710133","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pill Counting Tray","code_information":[{"code":"CP17744631830772540","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779629001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Robitussin   Liq","code_information":[{"code":"CP17744631830914092","type":"CDM"},{"code":"250","type":"RC"},{"code":"31875","type":"CPT","modifier":"12"}],"standard_charges":[{"setting":"outpatient","modifier_code":["12"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Robitussin Cf  Max Liq","code_information":[{"code":"CP17744631830916074","type":"CDM"},{"code":"250","type":"RC"},{"code":"31875","type":"CPT","modifier":"12"}],"standard_charges":[{"setting":"outpatient","modifier_code":["12"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830692677","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342025866","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Avalide      Tab 150-12.5","code_information":[{"code":"CP17744631828792301","type":"CDM"},{"code":"250","type":"RC"},{"code":"24585","type":"CPT","modifier":"530"}],"standard_charges":[{"setting":"outpatient","modifier_code":["530"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Baclofen     Inj 10mg/20","code_information":[{"code":"CP17744631828825844","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457056220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Imuran       Tab 50mg","code_information":[{"code":"CP17744631830138218","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766059010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ovace Plus   Cre 10%","code_information":[{"code":"CP17744631830690963","type":"CDM"},{"code":"250","type":"RC"},{"code":"17804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Crestor      Tab 10mg","code_information":[{"code":"CP17744631829436093","type":"CDM"},{"code":"250","type":"RC"},{"code":"31075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Crestor      Tab 20mg","code_information":[{"code":"CP17744631829430926","type":"CDM"},{"code":"250","type":"RC"},{"code":"31075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Crestor      Tab 5mg","code_information":[{"code":"CP17744631829434375","type":"CDM"},{"code":"250","type":"RC"},{"code":"31075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Crestor 10mg Tabs","code_information":[{"code":"CP17744631829439419","type":"CDM"},{"code":"250","type":"RC"},{"code":"31007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Crestor 5mg Tabs","code_information":[{"code":"CP17744631829437799","type":"CDM"},{"code":"250","type":"RC"},{"code":"31007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Eletriptan   Tab 20mg","code_information":[{"code":"CP17744631829774523","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651010469","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Eletriptan   Tab 20mg","code_information":[{"code":"CP17744631829777298","type":"CDM"},{"code":"250","type":"RC"},{"code":"93831","type":"CPT","modifier":"18"}],"standard_charges":[{"setting":"outpatient","modifier_code":["18"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Eletriptan   Tab 40mg","code_information":[{"code":"CP17744631829770629","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651010569","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829231335","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829231122","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877050430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829231543","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097041102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829238113","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829231537","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380088404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829230041","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829230712","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862083230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829232378","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335038083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cinacalcet   Tab 60mg","code_information":[{"code":"CP17744631829236676","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722010430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Oxacillin    Inj 2gm","code_information":[{"code":"CP17744631830708375","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631830700385","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2 Gm/50 Ml D5w","code_information":[{"code":"CP17744631830705430","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2gm/100ml D5w","code_information":[{"code":"CP17744631830707713","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Glargin Yfgn Sol 100u/ml","code_information":[{"code":"CP17744631830038980","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502039380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glar Sol 100u/ml","code_information":[{"code":"CP17744631830149802","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502039380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glargine 100 Un/ml Mdv","code_information":[{"code":"CP17744631830147372","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502039380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insulin Glargine 100u Vial","code_information":[{"code":"CP17744631830148649","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502039380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glargine-yfgn 100u V","code_information":[{"code":"CP17744631830143380","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502039380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Glargin-yfgn100u Vial","code_information":[{"code":"CP17744631830145199","type":"CDM"},{"code":"250","type":"RC"},{"code":"49502039380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Zolmitriptan Tab 5mg","code_information":[{"code":"CP17744631831400297","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462049833","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nexium       Cap 20mg","code_information":[{"code":"CP17744631830559984","type":"CDM"},{"code":"250","type":"RC"},{"code":"18650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nexium       Cap 20mg","code_information":[{"code":"CP17744631830551001","type":"CDM"},{"code":"250","type":"RC"},{"code":"18650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nexium       Cap 40mg","code_information":[{"code":"CP17744631830554573","type":"CDM"},{"code":"250","type":"RC"},{"code":"18650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Silver Collagen Dressing-2x2","code_information":[{"code":"CP17744631831019459","type":"CDM"},{"code":"250","type":"RC"},{"code":"16186","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain/mylanta/diphen/nystat","code_information":[{"code":"CP17744631830322235","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mw Nystatin/dexa","code_information":[{"code":"CP17744631830529063","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mylanta/diphen/nystat","code_information":[{"code":"CP17744631830529419","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nysta/hydrocort/benadryl","code_information":[{"code":"CP17744631830641078","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Sus 100000","code_information":[{"code":"CP17744631830655068","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Nystatin/benadryl/dexamethasoz","code_information":[{"code":"CP17744631830654398","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine 2%","code_information":[{"code":"CP17744631830652775","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine/alamag","code_information":[{"code":"CP17744631830657255","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine/benad","code_information":[{"code":"CP17744631830651805","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin-lidocaine-mylanta","code_information":[{"code":"CP17744631830650105","type":"CDM"},{"code":"250","type":"RC"},{"code":"12110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dronabinol   Cap 2.5mg","code_information":[{"code":"CP17744631829740858","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858086706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Foam Dressing Border 9x9","code_information":[{"code":"CP17744631829993645","type":"CDM"},{"code":"250","type":"RC"},{"code":"64656","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830924319","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714099001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830921062","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714099101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Blink Tears  Dro 0.25% Op","code_information":[{"code":"CP17744631828936040","type":"CDM"},{"code":"250","type":"RC"},{"code":"29943000215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Varenicline  Tab 1mg","code_information":[{"code":"CP17744631831246526","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687064821","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Risperidone   Tab 4mg Odt","code_information":[{"code":"CP17744631830901594","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884040391","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Risperidone  Tab 4mg Odt","code_information":[{"code":"CP17744631830908544","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884040391","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Carvedilol   Cap 10mg Er","code_information":[{"code":"CP17744631829139725","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784071313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Carvedilol   Cap 40mg Er","code_information":[{"code":"CP17744631829132801","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784071513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Soaanz       Tab 60mg","code_information":[{"code":"CP17744631831031250","type":"CDM"},{"code":"250","type":"RC"},{"code":"73502068713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Soaanz (Torsemide) 60mg Tabs","code_information":[{"code":"CP17744631831037954","type":"CDM"},{"code":"250","type":"RC"},{"code":"73502068713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Celexa       Tab 10mg","code_information":[{"code":"CP17744631829199836","type":"CDM"},{"code":"250","type":"RC"},{"code":"45640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dotti        Dis 0.075mg","code_information":[{"code":"CP17744631829720417","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162099508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Esomeprazole Gra 10mg Dr","code_information":[{"code":"CP17744631829811769","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097052734","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prempro      Tab","code_information":[{"code":"CP17744631830821957","type":"CDM"},{"code":"250","type":"RC"},{"code":"46110","type":"CPT","modifier":"711"}],"standard_charges":[{"setting":"outpatient","modifier_code":["711"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prempro      Tab 0.3-1.5","code_information":[{"code":"CP17744631830821074","type":"CDM"},{"code":"250","type":"RC"},{"code":"46110","type":"CPT","modifier":"511"}],"standard_charges":[{"setting":"outpatient","modifier_code":["511"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Asmanex Hfa   200 Mcg 120inh","code_information":[{"code":"CP17744631828765765","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Asmanex Hfa  Aer 200 Mcg","code_information":[{"code":"CP17744631828766522","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dotti        Dis 0.05mg","code_information":[{"code":"CP17744631829727134","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162099308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Norvasc      Tab 2.5mg","code_information":[{"code":"CP17744631830579351","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151035377","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Norvasc      Tab 5mg","code_information":[{"code":"CP17744631830570415","type":"CDM"},{"code":"250","type":"RC"},{"code":"69153","type":"CPT","modifier":"68"}],"standard_charges":[{"setting":"outpatient","modifier_code":["68"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Topiramate   Cap Er 100mg","code_information":[{"code":"CP17744631831151110","type":"CDM"},{"code":"250","type":"RC"},{"code":"83210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dotti        Dis 0.025mg","code_information":[{"code":"CP17744631829726164","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162098908","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dotti        Dis 0.0375mg","code_information":[{"code":"CP17744631829721579","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162099208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Enoxaparin   Inj 120/0.8","code_information":[{"code":"CP17744631829786035","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Heating      Pad Mst/dry","code_information":[{"code":"CP17744631830076316","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703001080","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycontin    Tab 15mg Cr","code_information":[{"code":"CP17744631830718646","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxycontin    Tab 15mg Er","code_information":[{"code":"CP17744631830711975","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxycontin 15mg Er Tab","code_information":[{"code":"CP17744631830720446","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxycontin Er 15mg Tabs","code_information":[{"code":"CP17744631830725038","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Juven        Pow Orange","code_information":[{"code":"CP17744631830186943","type":"CDM"},{"code":"250","type":"RC"},{"code":"59781066693","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Juven Powder Orange","code_information":[{"code":"CP17744631830180709","type":"CDM"},{"code":"250","type":"RC"},{"code":"59781066693","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Soothe Xp    Dro 1%-4.5%","code_information":[{"code":"CP17744631831057543","type":"CDM"},{"code":"250","type":"RC"},{"code":"10119049311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pramosone 1% Cream","code_information":[{"code":"CP17744631830807069","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766071604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bimatoprost  Sol 0.03%","code_information":[{"code":"CP17744631828884789","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332051105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Fluoromethol Sus 0.1% Op","code_information":[{"code":"CP17744631829970136","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219158503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Gel  Sol 0.25% Op","code_information":[{"code":"CP17744631831131982","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332054505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Skin Barrier Waf 44mm","code_information":[{"code":"CP17744631831020977","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380014904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking K-h X-l 20-30 Ot","code_information":[{"code":"CP17744631831079040","type":"CDM"},{"code":"250","type":"RC"},{"code":"55088740000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sulfo Lo     Bar 3%","code_information":[{"code":"CP17744631831073665","type":"CDM"},{"code":"250","type":"RC"},{"code":"31601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compression Stocking Kh","code_information":[{"code":"CP17744631829411879","type":"CDM"},{"code":"250","type":"RC"},{"code":"77448","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Suboxone     Mis 4-1mg","code_information":[{"code":"CP17744631831079933","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496120403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Suboxone     Mis 8-2mg","code_information":[{"code":"CP17744631831077889","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496120803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Suboxone 4-1mg Film","code_information":[{"code":"CP17744631831070480","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496120403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Suboxone Mis 8-2mg Film","code_information":[{"code":"CP17744631831074837","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496120803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Betaxolol    Sol 0.5% Op","code_information":[{"code":"CP17744631828872410","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314024502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Novolog      Inj Penfill","code_information":[{"code":"CP17744631830573309","type":"CDM"},{"code":"250","type":"RC"},{"code":"16933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Novolog Penfill 100 U/ml 3ml","code_information":[{"code":"CP17744631830642110","type":"CDM"},{"code":"250","type":"RC"},{"code":"16933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Elbow Support Strap","code_information":[{"code":"CP17744631829768496","type":"CDM"},{"code":"250","type":"RC"},{"code":"11590","type":"CPT","modifier":"89"}],"standard_charges":[{"setting":"outpatient","modifier_code":["89"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluphenaz De Inj 25mg/ml","code_information":[{"code":"CP17744631829973096","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150026705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamictal     Kit Start 49","code_information":[{"code":"CP17744631830209360","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Etravirine   Tab 200mg","code_information":[{"code":"CP17744631829822308","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219172206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830673170","type":"CDM"},{"code":"250","type":"RC"},{"code":"93500","type":"CPT","modifier":"656"}],"standard_charges":[{"setting":"outpatient","modifier_code":["656"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 75mcg/hr","code_information":[{"code":"CP17744631829857631","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042747","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Fentanyl     Dis 75mcg/hr","code_information":[{"code":"CP17744631829858369","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505700802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Fentanyl     Dis 75mcg/hr","code_information":[{"code":"CP17744631829857076","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Gentak       Oin 0.3% Op","code_information":[{"code":"CP17744631830028412","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478028435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Refresh Plus Dro 0.5% Op","code_information":[{"code":"CP17744631830887330","type":"CDM"},{"code":"250","type":"RC"},{"code":"23040","type":"CPT","modifier":"330"}],"standard_charges":[{"setting":"outpatient","modifier_code":["330"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prisma Collagen Dressing","code_information":[{"code":"CP17744631830838160","type":"CDM"},{"code":"250","type":"RC"},{"code":"63713004434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Promogran 4.34\" Dressing","code_information":[{"code":"CP17744631830845667","type":"CDM"},{"code":"250","type":"RC"},{"code":"63713004434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Promogran Collagen Dressing","code_information":[{"code":"CP17744631830845400","type":"CDM"},{"code":"250","type":"RC"},{"code":"63713004434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 30/0.3ml","code_information":[{"code":"CP17744631829784905","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Enoxaparin 30mg/0.3 Ml Dose","code_information":[{"code":"CP17744631829783045","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Edarbyclor   Tab 40-12.5","code_information":[{"code":"CP17744631829765194","type":"CDM"},{"code":"250","type":"RC"},{"code":"60631041230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Edarbyclor   Tab 40-25mg","code_information":[{"code":"CP17744631829769292","type":"CDM"},{"code":"250","type":"RC"},{"code":"60631042530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Edarbyclor 40/25mg Tab","code_information":[{"code":"CP17744631829768299","type":"CDM"},{"code":"250","type":"RC"},{"code":"60631042530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Hydroxyz Hcl Inj 50mg/ml","code_information":[{"code":"CP17744631830118287","type":"CDM"},{"code":"250","type":"RC"},{"code":"51756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Zioptan      Dro 0.0015%","code_information":[{"code":"CP17744631831409999","type":"CDM"},{"code":"250","type":"RC"},{"code":"82584060930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829990021","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748026130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Oxacillin    Inj 2gm","code_information":[{"code":"CP17744631830709826","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679069901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2g/ 0.9% Nacl 50ml","code_information":[{"code":"CP17744631830703405","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679069901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Alosetron    Tab 1mg","code_information":[{"code":"CP17744631828433938","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963048003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sitagliptin  Tab 100mg","code_information":[{"code":"CP17744631831027116","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710190103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enoxaparin   Inj 150mg/ml","code_information":[{"code":"CP17744631829783771","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ostomy Barrier","code_information":[{"code":"CP17744631830696060","type":"CDM"},{"code":"250","type":"RC"},{"code":"32540","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Shoe Post-op Men","code_information":[{"code":"CP17744631831012724","type":"CDM"},{"code":"250","type":"RC"},{"code":"70878000142","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vitamin K1   Inj 10mg/ml","code_information":[{"code":"CP17744631831303613","type":"CDM"},{"code":"250","type":"RC"},{"code":"40991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydrfra Blue Pad Rdy 2.5\"","code_information":[{"code":"CP17744631830091989","type":"CDM"},{"code":"250","type":"RC"},{"code":"8573011113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metaxalone   Tab 800mg","code_information":[{"code":"CP17744631830431290","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228032301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Allevyn Heel 4-1/2-5-51/2","code_information":[{"code":"CP17744631828416476","type":"CDM"},{"code":"250","type":"RC"},{"code":"40736","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dofetilide   Cap 500mcg","code_information":[{"code":"CP17744631829726524","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452013317","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cefixime     Cap 400mg","code_information":[{"code":"CP17744631829170907","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877058450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Estradiol    Dis 0.0375mg","code_information":[{"code":"CP17744631829810474","type":"CDM"},{"code":"250","type":"RC"},{"code":"37833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Ipratropium  Sol 0.02%inh","code_information":[{"code":"CP17744631830154959","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Jentadueto   Tab 2.5-1000","code_information":[{"code":"CP17744631830188807","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Jentadueto   Tab 2.5-500","code_information":[{"code":"CP17744631830183054","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Jentadueto 2.5/1000mg Tabs","code_information":[{"code":"CP17744631830181600","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Jentadueto Xr 2.5-1000mg Tb24","code_information":[{"code":"CP17744631830186051","type":"CDM"},{"code":"250","type":"RC"},{"code":"59702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sirolimus    Sol 1mg/ml","code_information":[{"code":"CP17744631831020174","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689034702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Depo-testost Inj 100mg/ml","code_information":[{"code":"CP17744631829557913","type":"CDM"},{"code":"250","type":"RC"},{"code":"90347","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829781178","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Ecoza        Aer 1%","code_information":[{"code":"CP17744631829760467","type":"CDM"},{"code":"250","type":"RC"},{"code":"23710010070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ecoza        Aer 1%","code_information":[{"code":"CP17744631829760641","type":"CDM"},{"code":"250","type":"RC"},{"code":"81811010070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Finacea      Aer 15%","code_information":[{"code":"CP17744631829957780","type":"CDM"},{"code":"250","type":"RC"},{"code":"50222030350","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Gengraf      Sol 100mg/ml","code_information":[{"code":"CP17744631830025910","type":"CDM"},{"code":"250","type":"RC"},{"code":"74726","type":"CPT","modifier":"950"}],"standard_charges":[{"setting":"outpatient","modifier_code":["950"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Moxifloxacin Sol Hcl 0.5%","code_information":[{"code":"CP17744631830513950","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Rapaflo      Cap 4mg","code_information":[{"code":"CP17744631830873270","type":"CDM"},{"code":"250","type":"RC"},{"code":"23614","type":"CPT","modifier":"730"}],"standard_charges":[{"setting":"outpatient","modifier_code":["730"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Cefoxitin 1gm/100ml Ns","code_information":[{"code":"CP17744631829176580","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021011020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Compro       Sup 25mg","code_information":[{"code":"CP17744631829419538","type":"CDM"},{"code":"250","type":"RC"},{"code":"57472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Prochlorper  Sup 25mg","code_information":[{"code":"CP17744631830836783","type":"CDM"},{"code":"250","type":"RC"},{"code":"71301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Skintegrity Wound Cleaner","code_information":[{"code":"CP17744631831029462","type":"CDM"},{"code":"250","type":"RC"},{"code":"19734400215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alinia       Sus 100/5ml","code_information":[{"code":"CP17744631828401619","type":"CDM"},{"code":"250","type":"RC"},{"code":"67546021221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831253021","type":"CDM"},{"code":"250","type":"RC"},{"code":"68025008230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Huber Needle","code_information":[{"code":"CP17744631830083957","type":"CDM"},{"code":"250","type":"RC"},{"code":"44470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Sol Ult Cont","code_information":[{"code":"CP17744631830690554","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885045802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Safety Ii Needle 20g X 1\"","code_information":[{"code":"CP17744631830923137","type":"CDM"},{"code":"250","type":"RC"},{"code":"11404150000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Safety Ii Needle 20g X 1\"-20g-","code_information":[{"code":"CP17744631830921166","type":"CDM"},{"code":"250","type":"RC"},{"code":"11404150000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ankle Brace  Mis Stabiliz","code_information":[{"code":"CP17744631828538983","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020391","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Refresh Liqu Dro 1% Op","code_information":[{"code":"CP17744631830883752","type":"CDM"},{"code":"250","type":"RC"},{"code":"23920","type":"CPT","modifier":"515"}],"standard_charges":[{"setting":"outpatient","modifier_code":["515"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin   Cap 250mg","code_information":[{"code":"CP17744631831236124","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559039120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin   Cap 250mg","code_information":[{"code":"CP17744631831234314","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781073002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin   Cap 250mg","code_information":[{"code":"CP17744631831233833","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin   Cap 250mg","code_information":[{"code":"CP17744631831236235","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559039150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin   Cap 250mg","code_information":[{"code":"CP17744631831232691","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180016713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Fluticasone  Spr 50mcg","code_information":[{"code":"CP17744631829982738","type":"CDM"},{"code":"250","type":"RC"},{"code":"53611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Miconazole 3 Kit Combo Pk","code_information":[{"code":"CP17744631830472530","type":"CDM"},{"code":"250","type":"RC"},{"code":"11300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Edarbi       Tab 40mg","code_information":[{"code":"CP17744631829762903","type":"CDM"},{"code":"250","type":"RC"},{"code":"60631004030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Cellcept     Sus 200mg/ml","code_information":[{"code":"CP17744631829193990","type":"CDM"},{"code":"250","type":"RC"},{"code":"40261","type":"CPT","modifier":"29"}],"standard_charges":[{"setting":"outpatient","modifier_code":["29"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Temozolomide Cap 20mg","code_information":[{"code":"CP17744631831111314","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080214","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Temozolomide Cap 20mg","code_information":[{"code":"CP17744631831112385","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571081751","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Temozolomide Cap 20mg","code_information":[{"code":"CP17744631831112825","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080251","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Betaxolol    Sol 0.5% Op","code_information":[{"code":"CP17744631828872011","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314024501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829783100","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enoxaparin   Inj 120/0.8","code_information":[{"code":"CP17744631829781061","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Enoxaparin   Inj 80/0.8ml","code_information":[{"code":"CP17744631829782473","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Enoxaparin 80mg/0.8 Ml Dose","code_information":[{"code":"CP17744631829786208","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Flurbiprofen Sol 0.03% Op","code_information":[{"code":"CP17744631829989311","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292072225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Lincomycin   Inj 300mg/ml","code_information":[{"code":"CP17744631830340966","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822035306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Proair Hfa   Aer","code_information":[{"code":"CP17744631830836369","type":"CDM"},{"code":"250","type":"RC"},{"code":"59310057922","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sharps Cont  Mis 8.2qt","code_information":[{"code":"CP17744631831016152","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/valsar Tab /Hctz","code_information":[{"code":"CP17744631828483261","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380019901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlodi/valsart/hctz10/160/12.5","code_information":[{"code":"CP17744631828483073","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380019901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chlord/clidi Cap 5-2.5mg","code_information":[{"code":"CP17744631829217475","type":"CDM"},{"code":"250","type":"RC"},{"code":"51293069601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phytonadione Tab 5mg","code_information":[{"code":"CP17744631830768226","type":"CDM"},{"code":"250","type":"RC"},{"code":"76282074030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Viokace      Tab 20880","code_information":[{"code":"CP17744631831279042","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562020810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20880,"type":"EA"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830533313","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Norvir       Pow 100mg","code_information":[{"code":"CP17744631830573480","type":"CDM"},{"code":"250","type":"RC"},{"code":"74339","type":"CPT","modifier":"930"}],"standard_charges":[{"setting":"outpatient","modifier_code":["930"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Norvir       Tab 100mg","code_information":[{"code":"CP17744631830578765","type":"CDM"},{"code":"250","type":"RC"},{"code":"74234","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Norvir 100mg Tabs","code_information":[{"code":"CP17744631830570132","type":"CDM"},{"code":"250","type":"RC"},{"code":"74333","type":"CPT","modifier":"330"}],"standard_charges":[{"setting":"outpatient","modifier_code":["330"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Plavix       Tab 75mg","code_information":[{"code":"CP17744631830787439","type":"CDM"},{"code":"250","type":"RC"},{"code":"24117","type":"CPT","modifier":"190"}],"standard_charges":[{"setting":"outpatient","modifier_code":["190"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pramosone    Oin 1%","code_information":[{"code":"CP17744631830804365","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766076304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Refresh P.m. Oin Op","code_information":[{"code":"CP17744631830880454","type":"CDM"},{"code":"250","type":"RC"},{"code":"23024","type":"CPT","modifier":"4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["4"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacosamide   Tab 150mg","code_information":[{"code":"CP17744631830205035","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714055001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Enoxaparin   Inj 40/0.4ml","code_information":[{"code":"CP17744631829780182","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Enoxaparin 40mg/0.4 Ml Dose","code_information":[{"code":"CP17744631829780195","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Enoxaparin 40mg/0.4ml Inj","code_information":[{"code":"CP17744631829786781","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ipratropium  Sol 0.02%inh","code_information":[{"code":"CP17744631830154422","type":"CDM"},{"code":"250","type":"RC"},{"code":"37879","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Ipratropium  Sol 0.02%inh","code_information":[{"code":"CP17744631830159417","type":"CDM"},{"code":"250","type":"RC"},{"code":"37879","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Oxycodone    Tab 15mg","code_information":[{"code":"CP17744631830711570","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858000301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Humalog Mix  Sus 75/25","code_information":[{"code":"CP17744631830086333","type":"CDM"},{"code":"250","type":"RC"},{"code":"27511","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Humalog Mix 75/25 Mdv 10ml","code_information":[{"code":"CP17744631830084088","type":"CDM"},{"code":"250","type":"RC"},{"code":"27511","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Apo-varenicl Tab 0.5mg","code_information":[{"code":"CP17744631828733568","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505476505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clonidine    Dis 0.2/24hr","code_information":[{"code":"CP17744631829370442","type":"CDM"},{"code":"250","type":"RC"},{"code":"37808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Tab 15mg","code_information":[{"code":"CP17744631830713594","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Savella      Tab 12.5mg","code_information":[{"code":"CP17744631830990022","type":"CDM"},{"code":"250","type":"RC"},{"code":"45615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Savella      Tab 25mg","code_information":[{"code":"CP17744631830990614","type":"CDM"},{"code":"250","type":"RC"},{"code":"45615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Savella      Tab 50mg","code_information":[{"code":"CP17744631830998183","type":"CDM"},{"code":"250","type":"RC"},{"code":"45615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Apidra       Inj U-100","code_information":[{"code":"CP17744631828723977","type":"CDM"},{"code":"250","type":"RC"},{"code":"88250","type":"CPT","modifier":"33"}],"standard_charges":[{"setting":"outpatient","modifier_code":["33"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Apidra 100 Units/ml  Mdv 10 Ml","code_information":[{"code":"CP17744631828727439","type":"CDM"},{"code":"250","type":"RC"},{"code":"88250","type":"CPT","modifier":"33"}],"standard_charges":[{"setting":"outpatient","modifier_code":["33"],"minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Temozolomide Cap 20mg","code_information":[{"code":"CP17744631831113134","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877053814","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Difluprednat Emu 0.05%","code_information":[{"code":"CP17744631829607487","type":"CDM"},{"code":"250","type":"RC"},{"code":"76282070850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloper Dec  Inj 50mg/ml","code_information":[{"code":"CP17744631830066903","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069038110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Keppra       Tab 250mg","code_information":[{"code":"CP17744631830187180","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474059440","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Naprox-esom  Tab 500-20mg","code_information":[{"code":"CP17744631830546964","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241020360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Stockings Knee High X-lg","code_information":[{"code":"CP17744631831074704","type":"CDM"},{"code":"250","type":"RC"},{"code":"3870393025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Temozolomide Cap 20mg","code_information":[{"code":"CP17744631831119819","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877053807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":7,"maximum":9,"gross_charge":9,"discounted_cash":9,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":9},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Insulin Aspa Inj Penfill","code_information":[{"code":"CP17744631830141502","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070010215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Aspart Penfill 3ml","code_information":[{"code":"CP17744631830144954","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070010215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Knee Brace Slip-on X-lge","code_information":[{"code":"CP17744631830198051","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189001694","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ryvent       Tab 6mg","code_information":[{"code":"CP17744631830925747","type":"CDM"},{"code":"250","type":"RC"},{"code":"15370013010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Lovaza       Cap 1gm","code_information":[{"code":"CP17744631830375944","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784042012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830439895","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228044501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Zolmitriptan Tab 5mg","code_information":[{"code":"CP17744631831401355","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241002238","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Enoxaparin   Inj 30/0.3ml","code_information":[{"code":"CP17744631829781481","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288041081","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Fenofibrate  Tab 120mg","code_information":[{"code":"CP17744631829851818","type":"CDM"},{"code":"250","type":"RC"},{"code":"11515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Pertzye      Cap 24000u","code_information":[{"code":"CP17744631830752594","type":"CDM"},{"code":"250","type":"RC"},{"code":"59767002401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":24000,"type":"UN"}},{"description":"Doxepin Hcl  Cre 5%","code_information":[{"code":"CP17744631829736247","type":"CDM"},{"code":"250","type":"RC"},{"code":"37881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Enoxaparin   Inj 30/0.3ml","code_information":[{"code":"CP17744631829781351","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Enoxaparin 30mg/0.3ml Soln","code_information":[{"code":"CP17744631829788451","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Post-op Men Shoe-lg","code_information":[{"code":"CP17744631830794041","type":"CDM"},{"code":"250","type":"RC"},{"code":"70878000107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Refresh Tear Dro 0.5% Op","code_information":[{"code":"CP17744631830889846","type":"CDM"},{"code":"250","type":"RC"},{"code":"23079","type":"CPT","modifier":"815"}],"standard_charges":[{"setting":"outpatient","modifier_code":["815"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Moxifloxacin 0.5% Ophth Soln","code_information":[{"code":"CP17744631830519102","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Moxifloxacin Sol Hcl 0.5%","code_information":[{"code":"CP17744631830518671","type":"CDM"},{"code":"250","type":"RC"},{"code":"83214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Moxifloxacin Sol Hcl 0.5%","code_information":[{"code":"CP17744631830516423","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862084003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Moxifloxacin Sol Hcl 0.5%","code_information":[{"code":"CP17744631830512070","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332050503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Moxifloxacin Sol Hcl 0.5%","code_information":[{"code":"CP17744631830519395","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180042201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Moxifloxacin Sol Hcl 0.5%","code_information":[{"code":"CP17744631830511799","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831176518","type":"CDM"},{"code":"250","type":"RC"},{"code":"70302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Eucerin Eczm Cre Rlf 1%","code_information":[{"code":"CP17744631829825820","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140001510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Varenicline  Tab 1mg","code_information":[{"code":"CP17744631831244927","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462089456","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cymbalta     Cap 20mg","code_information":[{"code":"CP17744631829440712","type":"CDM"},{"code":"250","type":"RC"},{"code":"23235","type":"CPT","modifier":"60"}],"standard_charges":[{"setting":"outpatient","modifier_code":["60"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Finger Splnt Mis Medium","code_information":[{"code":"CP17744631829954732","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917008154","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830433107","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010049601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830433240","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335030588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830430920","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241024001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830433720","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462052001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830431136","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180033801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformn Mod Tab 500mg Er","code_information":[{"code":"CP17744631830449395","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241024001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformn Mod Tab 500mg Er","code_information":[{"code":"CP17744631830448480","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010049601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformn Mod Tab 500mg Er","code_information":[{"code":"CP17744631830440478","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462052001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformn Mod Tab 500mg Er","code_information":[{"code":"CP17744631830446250","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180033801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nafcillin    Inj 2gm","code_information":[{"code":"CP17744631830536206","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Enoxaparin   Inj 300/3ml","code_information":[{"code":"CP17744631829788731","type":"CDM"},{"code":"250","type":"RC"},{"code":"54856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Meman/donepz Cap 28-10mg","code_information":[{"code":"CP17744631830417645","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238124703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Topiramate   Cap Er 100mg","code_information":[{"code":"CP17744631831152982","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382076906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Vardenafil   Tab 20mg","code_information":[{"code":"CP17744631831244669","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332023930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Escitalopram Sol 5mg/5ml","code_information":[{"code":"CP17744631829815217","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162070588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zolmitriptan Tab 2.5mg","code_information":[{"code":"CP17744631831405548","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462049776","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Naloxone     Inj 2mg/2ml","code_information":[{"code":"CP17744631830534623","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457099202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ob Complete  Cap Petite","code_information":[{"code":"CP17744631830652144","type":"CDM"},{"code":"250","type":"RC"},{"code":"68025005930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atazanavir   Cap 300mg","code_information":[{"code":"CP17744631828771069","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862071330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bicalutamide Tab 50mg","code_information":[{"code":"CP17744631828879539","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729002310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Enoxaparin   Inj 150mg/ml","code_information":[{"code":"CP17744631829783618","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714006610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lanthanum    Chw 500mg","code_information":[{"code":"CP17744631830215355","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180081942","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Fibracol     Mis Dressing","code_information":[{"code":"CP17744631829950067","type":"CDM"},{"code":"250","type":"RC"},{"code":"56091002494","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prevalite    Pow 4gm Pk","code_information":[{"code":"CP17744631830839906","type":"CDM"},{"code":"250","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Stocking T-h Small 15-20","code_information":[{"code":"CP17744631831072009","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 40/0.4ml","code_information":[{"code":"CP17744631829787961","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Enoxaparin 40mg/0.4ml Soln","code_information":[{"code":"CP17744631829786611","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Methylpr Ace Inj 40mg/ml","code_information":[{"code":"CP17744631830458049","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Methylpr Ace Inj 40mg/ml","code_information":[{"code":"CP17744631830455425","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121157301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Risperdal    Tab 2mg","code_information":[{"code":"CP17744631830891420","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458032006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tri-luma     Cre","code_information":[{"code":"CP17744631831195055","type":"CDM"},{"code":"250","type":"RC"},{"code":"29959","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Tab 20mg Er","code_information":[{"code":"CP17744631830712076","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238229601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Promethazine Sol Dm","code_information":[{"code":"CP17744631830849779","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162068090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipa 62.5/25 Inh (30)","code_information":[{"code":"CP17744631828536756","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipt 62.5-25 (30 Inh)","code_information":[{"code":"CP17744631828530013","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipt 62.5-25 30 Inh","code_information":[{"code":"CP17744631828539700","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipt 62.5-25 7 Inh","code_information":[{"code":"CP17744631828533672","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anoro Ellipt Aer 62.5-25","code_information":[{"code":"CP17744631828537834","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":625,"type":"EA"}},{"description":"Betaxolol    Sol 0.5% Op","code_information":[{"code":"CP17744631828879826","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478070511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Amlod/valsar Tab /Hctz","code_information":[{"code":"CP17744631828483598","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380019701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Elbow Suppor Mis Adjustbl","code_information":[{"code":"CP17744631829760195","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020063","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 120/0.8","code_information":[{"code":"CP17744631829781989","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603021510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Osphena      Tab 60mg","code_information":[{"code":"CP17744631830696801","type":"CDM"},{"code":"250","type":"RC"},{"code":"59630058090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Estrace Vag  Cre 0.01%","code_information":[{"code":"CP17744631829811136","type":"CDM"},{"code":"250","type":"RC"},{"code":"43037","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Creon        Cap 24000unt","code_information":[{"code":"CP17744631829421807","type":"CDM"},{"code":"250","type":"RC"},{"code":"32122","type":"CPT","modifier":"407"}],"standard_charges":[{"setting":"outpatient","modifier_code":["407"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":24000,"type":"EA"}},{"description":"Dextrose     Inj 5%","code_information":[{"code":"CP17744631829580533","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lurasidone   Tab 20mg","code_information":[{"code":"CP17744631830389642","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162087903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830382485","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162008203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 80mg","code_information":[{"code":"CP17744631830382120","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162088103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Mesalamine   Tab 800mg Dr","code_information":[{"code":"CP17744631830434771","type":"CDM"},{"code":"250","type":"RC"},{"code":"48077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Pantoprazole Pak 40mg","code_information":[{"code":"CP17744631830731202","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687076727","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Bijuva       Cap 1-100mg","code_information":[{"code":"CP17744631828879195","type":"CDM"},{"code":"250","type":"RC"},{"code":"50261021130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Haloper Dec  Inj 50mg/ml","code_information":[{"code":"CP17744631830066851","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288050202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Kombiglyz Xr Tab 2.5-1000","code_information":[{"code":"CP17744631830193134","type":"CDM"},{"code":"250","type":"RC"},{"code":"31061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Nystop       Pow 100000","code_information":[{"code":"CP17744631830659037","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystop 100000iu Powd","code_information":[{"code":"CP17744631830654078","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100000,"type":"F2"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830782490","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830787569","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Stocking K-h 20-30 Small","code_information":[{"code":"CP17744631831068511","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958848","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking K-h Medium 20-30","code_information":[{"code":"CP17744631831066060","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958849","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking Kh Small","code_information":[{"code":"CP17744631831075565","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958848","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexamethason Tab 6-day","code_information":[{"code":"CP17744631829576544","type":"CDM"},{"code":"250","type":"RC"},{"code":"68047070221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Hydralazine  Inj 20mg/ml","code_information":[{"code":"CP17744631830096670","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Skin Barrier Waf 44mm","code_information":[{"code":"CP17744631831022701","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380014402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alprazolam   Tab 2mg","code_information":[{"code":"CP17744631828456056","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991070705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lisdexamfeta Chw 40mg","code_information":[{"code":"CP17744631830348839","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664008688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Dronabinol   Cap 10mg","code_information":[{"code":"CP17744631829744633","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877075560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ryaltris     Spr 665-25","code_information":[{"code":"CP17744631830924562","type":"CDM"},{"code":"250","type":"RC"},{"code":"59467070027","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":665,"type":"EA"}},{"description":"Sterile      Inj Water","code_information":[{"code":"CP17744631831066857","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323018507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atazanavir   Cap 300mg","code_information":[{"code":"CP17744631828779541","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714086201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bimatoprost  Sol 0.03% Op","code_information":[{"code":"CP17744631828888601","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266013901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Dorzolamide  Sol 2% Op","code_information":[{"code":"CP17744631829725231","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208048510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Fentanyl     Dis 100mcg/h","code_information":[{"code":"CP17744631829853758","type":"CDM"},{"code":"250","type":"RC"},{"code":"40690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fluoromethol Sus 0.1% Op","code_information":[{"code":"CP17744631829979307","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219158606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830060478","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hot/cold     Pad Bead Pck","code_information":[{"code":"CP17744631830088189","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917015037","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketoconazole Sha 2%","code_information":[{"code":"CP17744631830184584","type":"CDM"},{"code":"250","type":"RC"},{"code":"63646001004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nicotine Td  Dis 14mg/24h","code_information":[{"code":"CP17744631830556389","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001043390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829780774","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Sock Aid     Mis Deluxe","code_information":[{"code":"CP17744631831039751","type":"CDM"},{"code":"250","type":"RC"},{"code":"54756054013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dutoprol     Tab 25-12.5","code_information":[{"code":"CP17744631829767341","type":"CDM"},{"code":"250","type":"RC"},{"code":"59212008730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Dutoprol 25/12.5mg Tabs","code_information":[{"code":"CP17744631829769065","type":"CDM"},{"code":"250","type":"RC"},{"code":"59212008730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Adrenalin    Inj 30/30ml","code_information":[{"code":"CP17744631828354849","type":"CDM"},{"code":"250","type":"RC"},{"code":"42023016801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Lorazepam    Pow","code_information":[{"code":"CP17744631830362878","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552072902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lorazepam 1mg/ml Top Gel","code_information":[{"code":"CP17744631830367246","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552072902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Oxycodone    Tab 15mg","code_information":[{"code":"CP17744631830710943","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702000850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Meloxicam    Cap 5mg","code_information":[{"code":"CP17744631830415335","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954007610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Futuro Knee Sleeve","code_information":[{"code":"CP17744631830011260","type":"CDM"},{"code":"250","type":"RC"},{"code":"5113120491","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mometasone   Cre 0.1%","code_information":[{"code":"CP17744631830497149","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alum Cane    Mis Adjustbl","code_information":[{"code":"CP17744631828457534","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601000545","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chlorpromazi Con 100mg/ml","code_information":[{"code":"CP17744631829213227","type":"CDM"},{"code":"250","type":"RC"},{"code":"78140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Everolimus   Tab 0.5 Mg","code_information":[{"code":"CP17744631829833388","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991038060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ipratropium  Sol 0.02%inh","code_information":[{"code":"CP17744631830156281","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204010030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Zolpidem Tar Cap 7.5mg","code_information":[{"code":"CP17744631831414736","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427077530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Genteal      Gel 0.3%","code_information":[{"code":"CP17744631830033364","type":"CDM"},{"code":"250","type":"RC"},{"code":"65806","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Melphalan    Tab 2mg","code_information":[{"code":"CP17744631830416313","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781020050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Belbuca      Mis 150mcg","code_information":[{"code":"CP17744631828854316","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Belbuca      Mis 75mcg","code_information":[{"code":"CP17744631828858150","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Belbuca 75mcg Film","code_information":[{"code":"CP17744631828853269","type":"CDM"},{"code":"250","type":"RC"},{"code":"59385002160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Desonide     Gel 0.05%","code_information":[{"code":"CP17744631829561031","type":"CDM"},{"code":"250","type":"RC"},{"code":"24470092060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Diclofenac   Sol 2%","code_information":[{"code":"CP17744631829590413","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748033501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Methylpr Ace Inj 40mg/ml","code_information":[{"code":"CP17744631830450100","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021082010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Boudreauxs   Oin 40%","code_information":[{"code":"CP17744631828949556","type":"CDM"},{"code":"250","type":"RC"},{"code":"62103032304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Chlorpromazi Con 100mg/ml","code_information":[{"code":"CP17744631829223804","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338041024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Octreotide   Inj 100mcg","code_information":[{"code":"CP17744631830656429","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457024501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Etravirine   Tab 100mg","code_information":[{"code":"CP17744631829825748","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219172107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Oxycodone    Tab 40mg Er","code_information":[{"code":"CP17744631830711834","type":"CDM"},{"code":"250","type":"RC"},{"code":"59126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Depakote     Tab 500mg Dr","code_information":[{"code":"CP17744631829558890","type":"CDM"},{"code":"250","type":"RC"},{"code":"74732","type":"CPT","modifier":"713"}],"standard_charges":[{"setting":"outpatient","modifier_code":["713"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Erythromycin 250mg Tabs","code_information":[{"code":"CP17744631829809797","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338010213","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Erythromycin Tab 250mg Bs","code_information":[{"code":"CP17744631829803904","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338010213","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Jesduvroq    Tab 2mg","code_information":[{"code":"CP17744631830188968","type":"CDM"},{"code":"250","type":"RC"},{"code":"17309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ketoconazole 2% Cream","code_information":[{"code":"CP17744631830183782","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Timolol Gel  Sol 0.5% Op","code_information":[{"code":"CP17744631831136012","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603016301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydrocodone  Cap 10mg Er","code_information":[{"code":"CP17744631830109641","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781040960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Calcium Alginate Ag","code_information":[{"code":"CP17744631829074977","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784030312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dynaginate+ag Calcium Alginate","code_information":[{"code":"CP17744631829764687","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784030312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aquaphor Adv Oin Healing","code_information":[{"code":"CP17744631828733776","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140003711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carnitor     Inj 1gm/5ml","code_information":[{"code":"CP17744631829134594","type":"CDM"},{"code":"250","type":"RC"},{"code":"54482014701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Durahesive   Waf 57mm 5x5","code_information":[{"code":"CP17744631829756319","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010622","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol 0.05mg/24hr Patch","code_information":[{"code":"CP17744631829823908","type":"CDM"},{"code":"250","type":"RC"},{"code":"37846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lido/silv/pet","code_information":[{"code":"CP17744631830324180","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834014130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Cre 5%","code_information":[{"code":"CP17744631830337561","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834014130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine 5% Cream","code_information":[{"code":"CP17744631830334114","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834014130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ssd/lidocaine5%/vaseline","code_information":[{"code":"CP17744631831063609","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834014130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc /Vit A&d/lidocaine/emolle","code_information":[{"code":"CP17744631831397370","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834014130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido/prilocn Cre 2.5-2.5%","code_information":[{"code":"CP17744631830321479","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Neurontin    Cap 300mg","code_information":[{"code":"CP17744631830556276","type":"CDM"},{"code":"250","type":"RC"},{"code":"71080","type":"CPT","modifier":"524"}],"standard_charges":[{"setting":"outpatient","modifier_code":["524"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Zypitamag    Tab 2mg","code_information":[{"code":"CP17744631831413765","type":"CDM"},{"code":"250","type":"RC"},{"code":"25208020109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Auryxia      Tab 210mg","code_information":[{"code":"CP17744631828797261","type":"CDM"},{"code":"250","type":"RC"},{"code":"59922063101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":210,"type":"ME"}},{"description":"Asmanex Hfa   100 Mcg 120inh","code_information":[{"code":"CP17744631828761312","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Asmanex Hfa  Aer 100 Mcg","code_information":[{"code":"CP17744631828767591","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dabigatran   Cap 75mg","code_information":[{"code":"CP17744631829465837","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877047460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829780988","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288041085","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Unasyn       Inj 1.5gm","code_information":[{"code":"CP17744631831208217","type":"CDM"},{"code":"250","type":"RC"},{"code":"49001","type":"CPT","modifier":"383"}],"standard_charges":[{"setting":"outpatient","modifier_code":["383"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Phytonadione Inj 10mg/ml","code_information":[{"code":"CP17744631830761940","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598040511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vitamin K1   Inj 1mg/0.5","code_information":[{"code":"CP17744631831307468","type":"CDM"},{"code":"250","type":"RC"},{"code":"40991","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830676282","type":"CDM"},{"code":"250","type":"RC"},{"code":"51293083885","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830670012","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862075705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830677384","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505057501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Allevyn Adh  Pad 5\"x5\"","code_information":[{"code":"CP17744631828413337","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/valsar Tab /Hctz","code_information":[{"code":"CP17744631828482256","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380020001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831175388","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Zioptan      Dro 0.0015%","code_information":[{"code":"CP17744631831401119","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478060930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cardura Xl   Tab 8mg","code_information":[{"code":"CP17744631829125631","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151007993","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Cardura Xl   Tab 8mg","code_information":[{"code":"CP17744631829126162","type":"CDM"},{"code":"250","type":"RC"},{"code":"49208","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Lurasidone   Tab 20mg","code_information":[{"code":"CP17744631830385023","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382096506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830380182","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598035230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830386429","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382096616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830383250","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382085906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 80mg","code_information":[{"code":"CP17744631830388612","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382096706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Lurasidone   Tab 20mg","code_information":[{"code":"CP17744631830386031","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877063830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lurasidone   Tab 20mg","code_information":[{"code":"CP17744631830380975","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729034610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lurasidone   Tab 20mg","code_information":[{"code":"CP17744631830382093","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335057883","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lurasidone   Tab 20mg","code_information":[{"code":"CP17744631830387714","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862095330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830384517","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729034710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830388835","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335068483","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830384650","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862095430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830386207","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877063930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830384722","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342042007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830380558","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729034810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830382399","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342042107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830381840","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877064030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830386477","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335063983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830382463","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862095530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830382405","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436009504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 80mg","code_information":[{"code":"CP17744631830385910","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729034910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Lurasidone   Tab 80mg","code_information":[{"code":"CP17744631830388664","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862095630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Lurasidone   Tab 80mg","code_information":[{"code":"CP17744631830389397","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335068583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Beta-phos/ac Inj 3-3mg/ml","code_information":[{"code":"CP17744631828871916","type":"CDM"},{"code":"250","type":"RC"},{"code":"51707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Lisdexamfeta Cap 20mg","code_information":[{"code":"CP17744631830341335","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lisdexamfeta Cap 30mg","code_information":[{"code":"CP17744631830346469","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781056401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lisdexamfeta Cap 60mg","code_information":[{"code":"CP17744631830342998","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781056701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lisdexamfeta Cap 60mg","code_information":[{"code":"CP17744631830344272","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858016601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lisdexamfeta Cap 70mg","code_information":[{"code":"CP17744631830345703","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505474501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Vancomycin   Inj 750mg","code_information":[{"code":"CP17744631831237913","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457070575","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Triamcinolon Pst Den 0.1%","code_information":[{"code":"CP17744631831181038","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980032005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 300/3ml","code_information":[{"code":"CP17744631829784444","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288042603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Genteal Tear Sol Moderate","code_information":[{"code":"CP17744631830034861","type":"CDM"},{"code":"250","type":"RC"},{"code":"65042","type":"CPT","modifier":"636"}],"standard_charges":[{"setting":"outpatient","modifier_code":["636"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lanthanum    Chw 1000mg","code_information":[{"code":"CP17744631830212953","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993042485","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Lanthanum Carb 1000mg Chew","code_information":[{"code":"CP17744631830224005","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993042485","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Valacyclovir Tab 1gm","code_information":[{"code":"CP17744631831212166","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722070530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Lurasidone   Tab 20mg","code_information":[{"code":"CP17744631830383934","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830386434","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 60mg","code_information":[{"code":"CP17744631830383061","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lurasidone   Tab 80mg","code_information":[{"code":"CP17744631830385345","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205021030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Mesalamine   Cap 500mg Er","code_information":[{"code":"CP17744631830433410","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304008913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830816581","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598029590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830827811","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Tetrabenazin Tab 25mg","code_information":[{"code":"CP17744631831113516","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682042225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dronabinol   Cap 5mg","code_information":[{"code":"CP17744631829749488","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687038621","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydralazine  Inj 20mg/ml","code_information":[{"code":"CP17744631830095069","type":"CDM"},{"code":"250","type":"RC"},{"code":"51709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Janumet      Tab 50-500mg","code_information":[{"code":"CP17744631830175274","type":"CDM"},{"code":"250","type":"RC"},{"code":"60575","type":"CPT","modifier":"62"}],"standard_charges":[{"setting":"outpatient","modifier_code":["62"],"minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Budesonide   Aer 2mg/act","code_information":[{"code":"CP17744631828957231","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682065803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nicotinamide Tab","code_information":[{"code":"CP17744631830557635","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192037460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"High Flow Rate Tubing","code_information":[{"code":"CP17744631830083543","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Elbow Brace  Mis Medium","code_information":[{"code":"CP17744631829762276","type":"CDM"},{"code":"250","type":"RC"},{"code":"86876014535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 120/0.8","code_information":[{"code":"CP17744631829783881","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Enoxaparin 120 Mg/0.8 Ml Dose","code_information":[{"code":"CP17744631829788756","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Sumatriptan  Tab 50mg","code_information":[{"code":"CP17744631831080047","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111029236","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Voriconazole Tab 200mg","code_information":[{"code":"CP17744631831302423","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862089230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Voriconazole Tab 200mg","code_information":[{"code":"CP17744631831306924","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547037803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Darunavir    Tab 600mg","code_information":[{"code":"CP17744631829543203","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205018460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Zolmitriptan Tab 2.5 Mg","code_information":[{"code":"CP17744631831404852","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980025616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atazanavir   Cap 300mg","code_information":[{"code":"CP17744631828771785","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097044602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Atazanavir   Cap 300mg","code_information":[{"code":"CP17744631828770571","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385092230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Amikacin     Inj 500/2ml","code_information":[{"code":"CP17744631828469470","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Amikacin 1.3gm/250ml Ns","code_information":[{"code":"CP17744631828462295","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":13,"type":"GR"}},{"description":"Amikacin 100mg/100ml Ns Irrig","code_information":[{"code":"CP17744631828468941","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amikacin 1500mg / 100ml Ns","code_information":[{"code":"CP17744631828468676","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1500,"type":"ME"}},{"description":"Amikacin 1500mg In 250ml Ns","code_information":[{"code":"CP17744631828463044","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1500,"type":"ME"}},{"description":"Amikacin 1gm In 100ml Ns","code_information":[{"code":"CP17744631828464385","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Amikacin 250mg In 100ml Ns","code_information":[{"code":"CP17744631828464944","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Amikacin 340mg In 100ml Ns","code_information":[{"code":"CP17744631828469453","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":340,"type":"ME"}},{"description":"Amikacin 400mg/ Ns 0.9% 100ml","code_information":[{"code":"CP17744631828464147","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Amikacin 460mg In 100ml Ns","code_information":[{"code":"CP17744631828469811","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":460,"type":"ME"}},{"description":"Amikacin 500mg/100ml Ns","code_information":[{"code":"CP17744631828464477","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Amikacin 670mg/100 Ml Ns","code_information":[{"code":"CP17744631828469833","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":670,"type":"ME"}},{"description":"Amikacin 700mg/100ml Ns","code_information":[{"code":"CP17744631828464474","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":700,"type":"ME"}},{"description":"Amikacin 750mg/100ml Ns","code_information":[{"code":"CP17744631828463936","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Doxepin Hcl 6mg","code_information":[{"code":"CP17744631829736081","type":"CDM"},{"code":"250","type":"RC"},{"code":"37848","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Erythromycin Oin 5mg/gm","code_information":[{"code":"CP17744631829807735","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gentamicin   Sol 0.3% Op","code_information":[{"code":"CP17744631830028453","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Ketoconazole Sha 2%","code_information":[{"code":"CP17744631830189080","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802046564","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lithostat    Tab 250mg","code_information":[{"code":"CP17744631830359454","type":"CDM"},{"code":"250","type":"RC"},{"code":"17805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Meman/donepz Cap 14-10mg","code_information":[{"code":"CP17744631830412338","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238124803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Microspacer  Mis","code_information":[{"code":"CP17744631830486261","type":"CDM"},{"code":"250","type":"RC"},{"code":"47360017201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831110993","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":8,"gross_charge":8,"discounted_cash":8,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":8},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Dermazinc    Bar Soap 2%","code_information":[{"code":"CP17744631829554530","type":"CDM"},{"code":"250","type":"RC"},{"code":"38344000020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Embrace      Sol Low","code_information":[{"code":"CP17744631829778212","type":"CDM"},{"code":"250","type":"RC"},{"code":"94030000207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 40/0.4ml","code_information":[{"code":"CP17744631829787548","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288041083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Enoxaparin 40mg/0.4 Ml Dose","code_information":[{"code":"CP17744631829785345","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288041083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rivastigmine Dis 9.5mg/24","code_information":[{"code":"CP17744631830908062","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714011602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Stocking K-h Large 20-30","code_information":[{"code":"CP17744631831068993","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Post-op Shoe X-lge Men","code_information":[{"code":"CP17744631830793041","type":"CDM"},{"code":"250","type":"RC"},{"code":"70878000222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"**On Indefinite Backorder**","code_information":[{"code":"CP17744631828032489","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"**On Indefinite Backorder**","code_information":[{"code":"CP17744631828067320","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Drizalma     Cap 30mg Dr","code_information":[{"code":"CP17744631829745567","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Drizalma     Cap 40mg Dr","code_information":[{"code":"CP17744631829749503","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Drizalma     Cap 60mg Dr","code_information":[{"code":"CP17744631829746405","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Atropine Sul Inj 1mg/ml","code_information":[{"code":"CP17744631828793346","type":"CDM"},{"code":"250","type":"RC"},{"code":"51710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Esomeprazole Gra 20mg Dr","code_information":[{"code":"CP17744631829818820","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097052834","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomeprazole Gra 40mg Dr","code_information":[{"code":"CP17744631829814783","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097052934","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Carbidopa    Tab 25mg","code_information":[{"code":"CP17744631829122252","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714006701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Renagel 800mg Tabs","code_information":[{"code":"CP17744631830886248","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468002101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828746505","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748025730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Namenda      Tab 10mg","code_information":[{"code":"CP17744631830539183","type":"CDM"},{"code":"250","type":"RC"},{"code":"45632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nitrofur Mac Cap 100mg","code_information":[{"code":"CP17744631830565980","type":"CDM"},{"code":"250","type":"RC"},{"code":"11516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Oxycodone    Tab 80mg Er","code_information":[{"code":"CP17744631830713403","type":"CDM"},{"code":"250","type":"RC"},{"code":"93573","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Rifabutin    Cap 150mg","code_information":[{"code":"CP17744631830897679","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762135001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Accu-chek    Sol","code_information":[{"code":"CP17744631828175668","type":"CDM"},{"code":"250","type":"RC"},{"code":"65702010710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desmopressin Spr 0.01%","code_information":[{"code":"CP17744631829566039","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208034205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desmopressin Spr 0.01%","code_information":[{"code":"CP17744631829566040","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382038401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biotene      Liq Dry Mth","code_information":[{"code":"CP17744631828888774","type":"CDM"},{"code":"250","type":"RC"},{"code":"48582000330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biotene Dry  Spr Moist","code_information":[{"code":"CP17744631828889540","type":"CDM"},{"code":"250","type":"RC"},{"code":"48582000155","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexlansopraz Cap 60mg Dr","code_information":[{"code":"CP17744631829579676","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979000206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Corvite Fe   Tab","code_information":[{"code":"CP17744631829426011","type":"CDM"},{"code":"250","type":"RC"},{"code":"68025006030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830651327","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zenzedi      Tab 20mg","code_information":[{"code":"CP17744631831393946","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338085510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Apap/codeine Tab 300-15mg","code_information":[{"code":"CP17744631828722784","type":"CDM"},{"code":"250","type":"RC"},{"code":"40604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830520895","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462056417","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828382841","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Brimonidine  Sol 0.2% Op","code_information":[{"code":"CP17744631828952617","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Oxacillin    Inj 2gm","code_information":[{"code":"CP17744631830705482","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 12gm/ns 1000 Ml","code_information":[{"code":"CP17744631830708973","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Oxacillin 2 Gm/100 Ml Ns Vm","code_information":[{"code":"CP17744631830701575","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2g / 100 Ml Elj","code_information":[{"code":"CP17744631830702173","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 2gm/100ml Ns","code_information":[{"code":"CP17744631830703206","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Oxacillin 6gm  In  500ml Ns","code_information":[{"code":"CP17744631830703515","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"GR"}},{"description":"Oxacillin2g/100ml Mb","code_information":[{"code":"CP17744631830701008","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Skin Barrier Mis 4\" X 4\"","code_information":[{"code":"CP17744631831020687","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380007700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Capecitabine 500mg Tabs","code_information":[{"code":"CP17744631829105613","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162084416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Hydrocort    Lot 1%","code_information":[{"code":"CP17744631830101122","type":"CDM"},{"code":"250","type":"RC"},{"code":"39408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kelly Forceps","code_information":[{"code":"CP17744631830186492","type":"CDM"},{"code":"250","type":"RC"},{"code":"48754","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pylera       Cap","code_information":[{"code":"CP17744631830852908","type":"CDM"},{"code":"250","type":"RC"},{"code":"58914060120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828791958","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478021515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cardura Xl   Tab 4mg","code_information":[{"code":"CP17744631829128032","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151007893","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Cardura Xl   Tab 4mg","code_information":[{"code":"CP17744631829122656","type":"CDM"},{"code":"250","type":"RC"},{"code":"49204","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Mico-zn-petr Oin","code_information":[{"code":"CP17744631830481647","type":"CDM"},{"code":"250","type":"RC"},{"code":"37882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Duoderm Cgf  Mis 4\"x4\"","code_information":[{"code":"CP17744631829758677","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010697","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829781266","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Pradaxa      Cap 150mg","code_information":[{"code":"CP17744631830809328","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830995215","type":"CDM"},{"code":"250","type":"RC"},{"code":"59122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Silver Alginate Wound 4x5","code_information":[{"code":"CP17744631831014725","type":"CDM"},{"code":"250","type":"RC"},{"code":"90201","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sitz Bath","code_information":[{"code":"CP17744631831020767","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247923068","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Theo-24      Cap 300mg Cr","code_information":[{"code":"CP17744631831128637","type":"CDM"},{"code":"250","type":"RC"},{"code":"52244030010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Dalfampridin Tab 10mg Er","code_information":[{"code":"CP17744631829470643","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729029212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sucralfate   Tab 1gm","code_information":[{"code":"CP17744631831079714","type":"CDM"},{"code":"250","type":"RC"},{"code":"93221","type":"CPT","modifier":"98"}],"standard_charges":[{"setting":"outpatient","modifier_code":["98"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tramadol Hcl Cap Er 100mg","code_information":[{"code":"CP17744631831157489","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811068930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dalfampridin Tab 10mg Er","code_information":[{"code":"CP17744631829479874","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862086360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829781106","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mepilex Border Dressing","code_information":[{"code":"CP17744631830423713","type":"CDM"},{"code":"250","type":"RC"},{"code":"32319010373","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Premarin     Tab 0.3mg","code_information":[{"code":"CP17744631830828665","type":"CDM"},{"code":"250","type":"RC"},{"code":"46110","type":"CPT","modifier":"81"}],"standard_charges":[{"setting":"outpatient","modifier_code":["81"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Premarin     Tab 0.45mg","code_information":[{"code":"CP17744631830820304","type":"CDM"},{"code":"250","type":"RC"},{"code":"46110","type":"CPT","modifier":"181"}],"standard_charges":[{"setting":"outpatient","modifier_code":["181"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Premarin     Tab 0.625mg","code_information":[{"code":"CP17744631830828649","type":"CDM"},{"code":"250","type":"RC"},{"code":"46110","type":"CPT","modifier":"281"}],"standard_charges":[{"setting":"outpatient","modifier_code":["281"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Premarin     Tab 0.9mg","code_information":[{"code":"CP17744631830822516","type":"CDM"},{"code":"250","type":"RC"},{"code":"46110","type":"CPT","modifier":"381"}],"standard_charges":[{"setting":"outpatient","modifier_code":["381"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Premarin     Tab 1.25mg","code_information":[{"code":"CP17744631830828096","type":"CDM"},{"code":"250","type":"RC"},{"code":"46110","type":"CPT","modifier":"481"}],"standard_charges":[{"setting":"outpatient","modifier_code":["481"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vancomycin   Inj 750mg","code_information":[{"code":"CP17744631831233958","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002421","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vilazodone   Tab 10mg","code_information":[{"code":"CP17744631831271727","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Docusate Sod Liq 50mg/5ml","code_information":[{"code":"CP17744631829711662","type":"CDM"},{"code":"250","type":"RC"},{"code":"12109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Estradiol    Dis 0.025mg","code_information":[{"code":"CP17744631829817593","type":"CDM"},{"code":"250","type":"RC"},{"code":"37833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Novolog      Inj 100/ml","code_information":[{"code":"CP17744631830575333","type":"CDM"},{"code":"250","type":"RC"},{"code":"16975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Novolog 100 Units/ml Mdv 10ml","code_information":[{"code":"CP17744631830577480","type":"CDM"},{"code":"250","type":"RC"},{"code":"16975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolog 100unit/ml Sol Vial","code_information":[{"code":"CP17744631830579557","type":"CDM"},{"code":"250","type":"RC"},{"code":"16975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolog 100unit/ml Soln","code_information":[{"code":"CP17744631830579281","type":"CDM"},{"code":"250","type":"RC"},{"code":"16975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Novolog Mix  Inj 70/30","code_information":[{"code":"CP17744631830578683","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolog Mix 70/30 Mdv 10ml","code_information":[{"code":"CP17744631830648006","type":"CDM"},{"code":"250","type":"RC"},{"code":"16936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Amcinonide   Cre 0.1%","code_information":[{"code":"CP17744631828461870","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Motofen      Tab 1-0.025","code_information":[{"code":"CP17744631830500624","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766020010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluphenaz De Inj 25mg/ml","code_information":[{"code":"CP17744631829977433","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457035959","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluphenaz De Inj 25mg/ml (5ml)","code_information":[{"code":"CP17744631829979556","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457035959","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Naproxen Sod Tab 500mg Cr","code_information":[{"code":"CP17744631830541120","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781015475","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Colcrys      Tab 0.6mg","code_information":[{"code":"CP17744631829400685","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764011907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colcrys      Tab 0.6mg","code_information":[{"code":"CP17744631829402331","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764011901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colcrys 0.6mg Tabs","code_information":[{"code":"CP17744631829406506","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764011907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Doxercalcif  Cap 0.5mcg","code_information":[{"code":"CP17744631829739154","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155053825","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Roflumilast  Tab 250mcg","code_information":[{"code":"CP17744631830915939","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722067636","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Asmanex Hfa   50mcg 120inh","code_information":[{"code":"CP17744631828769121","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Asmanex Hfa  Aer 50mcg","code_information":[{"code":"CP17744631828767029","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829408993","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714003901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830334566","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162079108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Envarsus Xr  Tab 1mg","code_information":[{"code":"CP17744631829790594","type":"CDM"},{"code":"250","type":"RC"},{"code":"68992301001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Envarsus Xr  Tab 1mg","code_information":[{"code":"CP17744631829795455","type":"CDM"},{"code":"250","type":"RC"},{"code":"68992301003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828794833","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478021505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ace Self-adh Mis Bndg 4\"","code_information":[{"code":"CP17744631828181658","type":"CDM"},{"code":"250","type":"RC"},{"code":"49022047627","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adderall Xr  Cap 10mg","code_information":[{"code":"CP17744631828344728","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092038301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Adderall Xr  Cap 20mg","code_information":[{"code":"CP17744631828346417","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092038701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Adderall Xr  Cap 25mg","code_information":[{"code":"CP17744631828352385","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092038901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Adderall Xr  Cap 30mg","code_information":[{"code":"CP17744631828353175","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092039101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Adderall Xr  Cap 5mg","code_information":[{"code":"CP17744631828356503","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092038101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dabigatran   Cap 150mg","code_information":[{"code":"CP17744631829468194","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687075232","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Dabigatran   Cap 75mg","code_information":[{"code":"CP17744631829467922","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687074421","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Dalfampridin Tab 10mg Er","code_information":[{"code":"CP17744631829472245","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877044460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dalfampridin Tab 10mg Er","code_information":[{"code":"CP17744631829470872","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756042986","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Depo-medrol  Inj 20mg/ml","code_information":[{"code":"CP17744631829557606","type":"CDM"},{"code":"250","type":"RC"},{"code":"90274","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829231487","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314065605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Lansoprazole Tab 30mg Odt","code_information":[{"code":"CP17744631830218529","type":"CDM"},{"code":"250","type":"RC"},{"code":"37869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Depakote     Tab 500mg Dr","code_information":[{"code":"CP17744631829551481","type":"CDM"},{"code":"250","type":"RC"},{"code":"74621","type":"CPT","modifier":"513"}],"standard_charges":[{"setting":"outpatient","modifier_code":["513"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Gatifloxacin Sol 0.5%","code_information":[{"code":"CP17744631830023083","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383018902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Gatifloxacin Sol 0.5%","code_information":[{"code":"CP17744631830025242","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758061525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Xtampza Er   Cap 9mg","code_information":[{"code":"CP17744631831384576","type":"CDM"},{"code":"250","type":"RC"},{"code":"24510011010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Lo Loestrin  Tab 1-10-10","code_information":[{"code":"CP17744631830351763","type":"CDM"},{"code":"250","type":"RC"},{"code":"43004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitroglycern Sub 0.3mg","code_information":[{"code":"CP17744631830562900","type":"CDM"},{"code":"250","type":"RC"},{"code":"69339017301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Serevent Dis Aer 50mcg","code_information":[{"code":"CP17744631831008548","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Serevent Disk Aer 50mcg 60inh","code_information":[{"code":"CP17744631831000145","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Serevent Diskus 50mcg Inhaler","code_information":[{"code":"CP17744631831005054","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ace Elastic  Mis Bndg 6\"","code_information":[{"code":"CP17744631828183365","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828389531","type":"CDM"},{"code":"250","type":"RC"},{"code":"37882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Dextroamphet Tab 5mg","code_information":[{"code":"CP17744631829580259","type":"CDM"},{"code":"250","type":"RC"},{"code":"11534018801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ampicillin 2 Gm/100ml Ns Mb Kt","code_information":[{"code":"CP17744631828527295","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin2gm/100ml","code_information":[{"code":"CP17744631828527367","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485042210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Voriconazole Tab 200mg","code_information":[{"code":"CP17744631831309494","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687027321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Methylphenid Cap 60mg","code_information":[{"code":"CP17744631830453924","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Rizatriptan  Tab 10mg","code_information":[{"code":"CP17744631830905462","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862060012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Skin Barrier Waf 57mm","code_information":[{"code":"CP17744631831026727","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380014803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sutab        Tab","code_information":[{"code":"CP17744631831087977","type":"CDM"},{"code":"250","type":"RC"},{"code":"52268020101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 250mg Er","code_information":[{"code":"CP17744631830216517","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884060411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Pancreaze    Cap 21000unt","code_information":[{"code":"CP17744631830737101","type":"CDM"},{"code":"250","type":"RC"},{"code":"62541040510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":21000,"type":"EA"}},{"description":"Sub Q 26g X12mm","code_information":[{"code":"CP17744631831072282","type":"CDM"},{"code":"250","type":"RC"},{"code":"12612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":26,"type":"GR"}},{"description":"Brimonidine  Sol 0.15%","code_information":[{"code":"CP17744631828958803","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505056401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829752289","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241009810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine Hcl Cap 30mg","code_information":[{"code":"CP17744631829754182","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241009810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Eszopiclone  Tab 1mg","code_information":[{"code":"CP17744631829820947","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862096730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Timolol Gel  Sol 0.5% Op","code_information":[{"code":"CP17744631831130544","type":"CDM"},{"code":"250","type":"RC"},{"code":"82260081905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydrofera    Pad Blue 2x2","code_information":[{"code":"CP17744631830119169","type":"CDM"},{"code":"250","type":"RC"},{"code":"8573012214","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketorolac    Sol 0.5%","code_information":[{"code":"CP17744631830199844","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505100301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828942458","type":"CDM"},{"code":"250","type":"RC"},{"code":"71921018805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Atomoxetine  Cap 60mg","code_information":[{"code":"CP17744631828784989","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714075901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Micropore    Tap 1/2x10yd","code_information":[{"code":"CP17744631830480225","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333153000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Natura Durahesive 04593","code_information":[{"code":"CP17744631830547418","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010453","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pyridostigmi Tab 30mg","code_information":[{"code":"CP17744631830856932","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657081021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Arnuity Elpt  50mcg (30 Inh)","code_information":[{"code":"CP17744631828754875","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Arnuity Elpt 100mcg (30 Inh)","code_information":[{"code":"CP17744631828753324","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Arnuity Elpt Inh 100mcg","code_information":[{"code":"CP17744631828753882","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Arnuity Elpt Inh 50mcg","code_information":[{"code":"CP17744631828758780","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Erythromycin Tab 250mg Bs","code_information":[{"code":"CP17744631829809689","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536010313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Iv Huber Needle 20gx1","code_information":[{"code":"CP17744631830174347","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"032","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":7,"discounted_cash":7}]},{"description":"Carvedilol   Cap 10mg Er","code_information":[{"code":"CP17744631829139835","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664066383","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Carvedilol  Er 10mg Caps","code_information":[{"code":"CP17744631829135642","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664066383","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydrocort Ac Sup 30mg","code_information":[{"code":"CP17744631830117348","type":"CDM"},{"code":"250","type":"RC"},{"code":"71321060312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Slynd        Tab 4mg","code_information":[{"code":"CP17744631831031515","type":"CDM"},{"code":"250","type":"RC"},{"code":"64274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Deplin 15    Cap","code_information":[{"code":"CP17744631829556269","type":"CDM"},{"code":"250","type":"RC"},{"code":"52511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Deplin Fc    Cap 7.5mg","code_information":[{"code":"CP17744631829556463","type":"CDM"},{"code":"250","type":"RC"},{"code":"52511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Wrist Slip-on Sportaid","code_information":[{"code":"CP17744631831380089","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189001671","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylpr Ace Inj 40mg/ml","code_information":[{"code":"CP17744631830454736","type":"CDM"},{"code":"250","type":"RC"},{"code":"70300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Oxycodone    Tab 10mg","code_information":[{"code":"CP17744631830713728","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702005650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bengay       Cre Ultra St","code_information":[{"code":"CP17744631828854482","type":"CDM"},{"code":"250","type":"RC"},{"code":"74300008194","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloperidol 5mg/ml Mdv","code_information":[{"code":"CP17744631830074255","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hyoscyamine  Dro 0.125/ml","code_information":[{"code":"CP17744631830123202","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135051352","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830724553","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808022501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830722397","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335076783","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830737426","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162028303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830730522","type":"CDM"},{"code":"250","type":"RC"},{"code":"37839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Acitretin    Cap 25mg","code_information":[{"code":"CP17744631828323450","type":"CDM"},{"code":"250","type":"RC"},{"code":"11517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clopidogrel  Tab 300mg","code_information":[{"code":"CP17744631829385001","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268018412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lorazepam    Con 2mg/ml","code_information":[{"code":"CP17744631830362120","type":"CDM"},{"code":"250","type":"RC"},{"code":"12107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lorazepam 0.5 Mg/0.25 Ml Pfs","code_information":[{"code":"CP17744631830363457","type":"CDM"},{"code":"250","type":"RC"},{"code":"12107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830721294","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714086901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Mirabegron   Tab 25mg Er","code_information":[{"code":"CP17744631830490490","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Durahesive   Waf 45mm","code_information":[{"code":"CP17744631829753066","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010639","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluorouracil Sol 5%","code_information":[{"code":"CP17744631829970081","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672406301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Insulin Aspa Inj 100/ml","code_information":[{"code":"CP17744631830141535","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insulin Aspart 100 Un/ml Mdv","code_information":[{"code":"CP17744631830143308","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insulin Aspart 100unit/ml Soln","code_information":[{"code":"CP17744631830148680","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Insulin Aspart 100unit/ml Vial","code_information":[{"code":"CP17744631830147144","type":"CDM"},{"code":"250","type":"RC"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Ranexa 500mg Tabs","code_information":[{"code":"CP17744631830871985","type":"CDM"},{"code":"250","type":"RC"},{"code":"61958100301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Daptomyc 400mg/100ml 0.9% Nacl","code_information":[{"code":"CP17744631829486906","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Daptomycin 900 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829546624","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Deferasirox  Tab 90mg","code_information":[{"code":"CP17744631829557073","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722001130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Dronabinol   Cap 10mg","code_information":[{"code":"CP17744631829744323","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858086906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Gentamicin 180mg/100ml Ns","code_information":[{"code":"CP17744631830037187","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Gentamicin 300mg/100ml Ns","code_information":[{"code":"CP17744631830030675","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Levothyroxin Cap 88mcg","code_information":[{"code":"CP17744631830314182","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831044627","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sodium Chlo-0.9% Iv Bag 100ml","code_information":[{"code":"CP17744631831049096","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"D5w/lr       Inj","code_information":[{"code":"CP17744631829455372","type":"CDM"},{"code":"250","type":"RC"},{"code":"33801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Cre 0.05%","code_information":[{"code":"CP17744631829975304","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238153405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydrocodone  Cap 15mg Er","code_information":[{"code":"CP17744631830107325","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781041060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Methylpr Ace Inj 40mg/ml","code_information":[{"code":"CP17744631830457701","type":"CDM"},{"code":"250","type":"RC"},{"code":"70300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Aripiprazole 30mg Tabs","code_information":[{"code":"CP17744631828746790","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729028310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828745220","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668022130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828748165","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722083030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828745608","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729028310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828752956","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862066630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Huber Infusin Set","code_information":[{"code":"CP17744631830084079","type":"CDM"},{"code":"250","type":"RC"},{"code":"68310200000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amp/sul 3 Gram/100 Ml El-j","code_information":[{"code":"CP17744631828517021","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603033510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Fentanyl     Dis 75mcg/hr","code_information":[{"code":"CP17744631829856224","type":"CDM"},{"code":"250","type":"RC"},{"code":"40690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831171978","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121104905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Breo Ellipta  100-25  (30 Inh)","code_information":[{"code":"CP17744631828947085","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  100-25  (60 Inh)","code_information":[{"code":"CP17744631828944590","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  200-25  (30inh)","code_information":[{"code":"CP17744631828945573","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  200-25  (60blis)","code_information":[{"code":"CP17744631828942429","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  200-25  (60inh)","code_information":[{"code":"CP17744631828942248","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  200-25 (30 Dose)","code_information":[{"code":"CP17744631828948162","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta Inh 100-25","code_information":[{"code":"CP17744631828941075","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta Inh 200-25","code_information":[{"code":"CP17744631828947330","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclobenzapr Cap 15mg Er","code_information":[{"code":"CP17744631829434652","type":"CDM"},{"code":"250","type":"RC"},{"code":"11514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Cyclobenzapr Cap 30mg Er","code_information":[{"code":"CP17744631829434090","type":"CDM"},{"code":"250","type":"RC"},{"code":"93192","type":"CPT","modifier":"106"}],"standard_charges":[{"setting":"outpatient","modifier_code":["106"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cyclobenzapr Cap 30mg Er","code_information":[{"code":"CP17744631829438994","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505397306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cyclobenzapr Cap 30mg Er","code_information":[{"code":"CP17744631829432269","type":"CDM"},{"code":"250","type":"RC"},{"code":"11514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cyclobenzaprine Er 15mg Caps","code_information":[{"code":"CP17744631829447482","type":"CDM"},{"code":"250","type":"RC"},{"code":"11514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Tegretol-xr  Tab 400mg","code_information":[{"code":"CP17744631831108309","type":"CDM"},{"code":"250","type":"RC"},{"code":"78051","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831255702","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834021830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Aripiprazole 30mg Tabs","code_information":[{"code":"CP17744631828742811","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828744701","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Caffeine Citrate 60mg/3ml Soln","code_information":[{"code":"CP17744631829056737","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754050001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Gg/codeine   Sol 100-10/5","code_information":[{"code":"CP17744631830039620","type":"CDM"},{"code":"250","type":"RC"},{"code":"12107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828380698","type":"CDM"},{"code":"250","type":"RC"},{"code":"48795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Remeron      Tab 15mg","code_information":[{"code":"CP17744631830888845","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aripiprazole 30mg Tabs","code_information":[{"code":"CP17744631828744336","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342012707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828744201","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Aripiprazole Tab 30mg","code_information":[{"code":"CP17744631828753660","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cyclogyl     Sol 0.5% Op","code_information":[{"code":"CP17744631829441494","type":"CDM"},{"code":"250","type":"RC"},{"code":"65039","type":"CPT","modifier":"515"}],"standard_charges":[{"setting":"outpatient","modifier_code":["515"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Amitiza      Cap 24mcg","code_information":[{"code":"CP17744631828471529","type":"CDM"},{"code":"250","type":"RC"},{"code":"23635052460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Amitiza      Cap 8mcg","code_information":[{"code":"CP17744631828478744","type":"CDM"},{"code":"250","type":"RC"},{"code":"23635050860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Curos Disinfecting Caps","code_information":[{"code":"CP17744631829431101","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin 1750mg/350ml El-l","code_information":[{"code":"CP17744631831249467","type":"CDM"},{"code":"250","type":"RC"},{"code":"72078006550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1750,"type":"ME"}},{"description":"Bystolic     Tab 10mg","code_information":[{"code":"CP17744631829047131","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bystolic     Tab 2.5mg","code_information":[{"code":"CP17744631829056395","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bystolic     Tab 20mg","code_information":[{"code":"CP17744631829055037","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Bystolic     Tab 5mg","code_information":[{"code":"CP17744631829055115","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Jobst 8-15mmhg Knee Beige","code_information":[{"code":"CP17744631830182007","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566419328","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biopatch     Mis 1\"/4mm","code_information":[{"code":"CP17744631828881687","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137002150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hc/acet Acid Sol Otic","code_information":[{"code":"CP17744631830071216","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672300701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 80/0.8ml","code_information":[{"code":"CP17744631829788990","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603019510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Pradaxa      Cap 75mg","code_information":[{"code":"CP17744631830805802","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831178435","type":"CDM"},{"code":"250","type":"RC"},{"code":"70302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Dapaglif-met Tab 5-1000mg","code_information":[{"code":"CP17744631829478796","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993036160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir    Tab 0.5mg","code_information":[{"code":"CP17744631829796582","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547043603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir    Tab 0.5mg","code_information":[{"code":"CP17744631829797066","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097042602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir    Tab 0.5mg","code_information":[{"code":"CP17744631829794940","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862084130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir    Tab 0.5mg","code_information":[{"code":"CP17744631829790003","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806065830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir    Tab 1mg","code_information":[{"code":"CP17744631829799331","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806065930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Paliperidone Er 9mg Tabs","code_information":[{"code":"CP17744631830725446","type":"CDM"},{"code":"250","type":"RC"},{"code":"10147095403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Seroquel     Tab 100mg","code_information":[{"code":"CP17744631831009855","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Entecavir    Tab 0.5mg","code_information":[{"code":"CP17744631829793260","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714071701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir    Tab 0.5mg","code_information":[{"code":"CP17744631829795085","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722083330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir    Tab 1mg","code_information":[{"code":"CP17744631829793169","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714071801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Entecavir    Tab 1mg","code_information":[{"code":"CP17744631829799692","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722083430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Entecavir 0.5mg Tabs","code_information":[{"code":"CP17744631829794747","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722083330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Entecavir 0.5mg Tabs","code_information":[{"code":"CP17744631829794754","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714071701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Coq10","code_information":[{"code":"CP17744631829417497","type":"CDM"},{"code":"250","type":"RC"},{"code":"8770141270","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"T.e.d.       Mis Lg/reg","code_information":[{"code":"CP17744631831095034","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080322110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cane/standar Mis Blk Hand","code_information":[{"code":"CP17744631829102243","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703030371","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefazolin    Inj 10gm","code_information":[{"code":"CP17744631829145260","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Cefazolin 2gm In 100ml Ns","code_information":[{"code":"CP17744631829156061","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Ns","code_information":[{"code":"CP17744631829158472","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin6g/1000ml Ns","code_information":[{"code":"CP17744631829154665","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"GR"}},{"description":"Difluprednat Emu 0.05%","code_information":[{"code":"CP17744631829605381","type":"CDM"},{"code":"250","type":"RC"},{"code":"78160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hc / Iodoquinol 1.9-1% Cr","code_information":[{"code":"CP17744631830075393","type":"CDM"},{"code":"250","type":"RC"},{"code":"52191035230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humalog      Inj 100/ml","code_information":[{"code":"CP17744631830081014","type":"CDM"},{"code":"250","type":"RC"},{"code":"27533","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"A&d Orig/nyst Cr/zno Oint","code_information":[{"code":"CP17744631828092179","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aquaphor/nystatin Cr/zincox20%","code_information":[{"code":"CP17744631828734282","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bacitracin, Zinc,nystatin","code_information":[{"code":"CP17744631828820639","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betamethasone Cr/nyst  Cr","code_information":[{"code":"CP17744631828871240","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biopatch","code_information":[{"code":"CP17744631828887047","type":"CDM"},{"code":"250","type":"RC"},{"code":"56091004150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biopatch Pro Mis Disk/chg","code_information":[{"code":"CP17744631828882372","type":"CDM"},{"code":"250","type":"RC"},{"code":"56091004150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desitin/ A&d/gerilanta/nystati","code_information":[{"code":"CP17744631829567448","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desitin/nystatin Cream","code_information":[{"code":"CP17744631829569292","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dest/nystatin/cholest/mylanta","code_information":[{"code":"CP17744631829560484","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dimethico Cr5/nystat Cr100,000","code_information":[{"code":"CP17744631829708786","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eryped       Sus 400/5ml","code_information":[{"code":"CP17744631829803847","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338013013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Hydrocort 2.5%/nys 1:1 Cream","code_information":[{"code":"CP17744631830103598","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydrocort Cre /Nystatin Cre","code_information":[{"code":"CP17744631830116963","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lid3-tri0.1-nys-zin20 1:1:1:2","code_information":[{"code":"CP17744631830323383","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine/zinc/nystatin Cream","code_information":[{"code":"CP17744631830346909","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido-triam-nyst-zinc Cream","code_information":[{"code":"CP17744631830349034","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nys/lido/zinc/hc","code_information":[{"code":"CP17744631830641957","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nyst/hydrocort/ssd/zno Crea","code_information":[{"code":"CP17744631830643522","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystain Cream +Zinc Oxide Oint","code_information":[{"code":"CP17744631830649236","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatdesitalum Hydrox","code_information":[{"code":"CP17744631830647623","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/zno/ A&d/ Gerilanta","code_information":[{"code":"CP17744631830649165","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Cre 100000","code_information":[{"code":"CP17744631830645254","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Nystatinmiconazole Cr 1:1","code_information":[{"code":"CP17744631830655043","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin And Zinc Cream 13 %","code_information":[{"code":"CP17744631830659915","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":13,"type":"EA"}},{"description":"Nystatin Cream / Zinc Oxid 20%","code_information":[{"code":"CP17744631830651212","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Nystatin Cream/hc Cream","code_information":[{"code":"CP17744631830654186","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin Cream/hc Cream/ssd","code_information":[{"code":"CP17744631830652872","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/hcz 1%/zinc 20%","code_information":[{"code":"CP17744631830654631","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/hcz 2.5%/zinc 20%","code_information":[{"code":"CP17744631830659846","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/hydroco 0.5%/zinc","code_information":[{"code":"CP17744631830650618","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/hydroco 1%/zinc","code_information":[{"code":"CP17744631830650384","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine/zinc","code_information":[{"code":"CP17744631830650518","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/mylanta/zno/cholestyr","code_information":[{"code":"CP17744631830659835","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/ssd/hydrocort1","code_information":[{"code":"CP17744631830658280","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/triam/zinc 1:1:1","code_information":[{"code":"CP17744631830657725","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/zinc Oxide/hydrocort1","code_information":[{"code":"CP17744631830656960","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/zno/lido/hc Cream","code_information":[{"code":"CP17744631830657475","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/znox/mylanta","code_information":[{"code":"CP17744631830654509","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pet 42%-nystatin-zinc Oint","code_information":[{"code":"CP17744631830751399","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":42,"type":"EA"}},{"description":"Pirfenidone  Tab 267mg","code_information":[{"code":"CP17744631830782963","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332047964","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":267,"type":"ME"}},{"description":"Sevelam Hcl  Tab 800mg","code_information":[{"code":"CP17744631831008535","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831014788","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl 800mg Tab","code_information":[{"code":"CP17744631831015304","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl 800mg Tabs","code_information":[{"code":"CP17744631831018213","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Silver S Crm 1% / Nystatin/myl","code_information":[{"code":"CP17744631831018501","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc / Nystat/mylanta /Cholest","code_information":[{"code":"CP17744631831390140","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide/alum+mag/nystcrm","code_information":[{"code":"CP17744631831407076","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide/nystatin Cre","code_information":[{"code":"CP17744631831405078","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide/nystatin Cre/ad Oin","code_information":[{"code":"CP17744631831408967","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide/nystatin Cre/micona","code_information":[{"code":"CP17744631831405006","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc/nystatin/aqua Butt Oint","code_information":[{"code":"CP17744631831407241","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zno/nystatin Cre/ad Oin/maalox","code_information":[{"code":"CP17744631831407585","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zno/nystatin Cre/nys Po/maalox","code_information":[{"code":"CP17744631831408184","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zno/nystatin/bacitracin/petro","code_information":[{"code":"CP17744631831402099","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Apo-varenicl Tab 1mg","code_information":[{"code":"CP17744631828738855","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505476606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Apo-varenicline 1mg","code_information":[{"code":"CP17744631828730248","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505476606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cardura Xl   Tab 4mg","code_information":[{"code":"CP17744631829126171","type":"CDM"},{"code":"250","type":"RC"},{"code":"49271","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Cast Protector Arm Adult","code_information":[{"code":"CP17744631829140793","type":"CDM"},{"code":"250","type":"RC"},{"code":"80196031234","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ostomy Belt  Mis Adjustab","code_information":[{"code":"CP17744631830696791","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clozaril     Tab 25mg","code_information":[{"code":"CP17744631829399182","type":"CDM"},{"code":"250","type":"RC"},{"code":"69809012605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Armodafinil  Tab 250mg","code_information":[{"code":"CP17744631828754429","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862080730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azelastine   Dro 0.05%","code_information":[{"code":"CP17744631828801062","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069009101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 250mg Er","code_information":[{"code":"CP17744631830211435","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722024430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Oxycod/apap  Tab 5-325mg","code_information":[{"code":"CP17744631830714378","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858010201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Arnicare     Cre Arnica","code_information":[{"code":"CP17744631828757497","type":"CDM"},{"code":"250","type":"RC"},{"code":"22090","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hose T.e.d. Sm-rg Hos","code_information":[{"code":"CP17744631830089723","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290207071","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"T.e.d.       Mis Knee","code_information":[{"code":"CP17744631831099851","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290207071","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Toe Crest","code_information":[{"code":"CP17744631831144916","type":"CDM"},{"code":"250","type":"RC"},{"code":"11769014611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 25mcg/hr","code_information":[{"code":"CP17744631829856862","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781042447","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mentax       Cre 1%","code_information":[{"code":"CP17744631830428863","type":"CDM"},{"code":"250","type":"RC"},{"code":"37861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 80/0.8ml","code_information":[{"code":"CP17744631829780206","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":8,"type":"ML"}},{"description":"Posaconazole Sus 40mg/ml","code_information":[{"code":"CP17744631830787977","type":"CDM"},{"code":"250","type":"RC"},{"code":"54044","type":"CPT","modifier":"949"}],"standard_charges":[{"setting":"outpatient","modifier_code":["949"],"minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Doxycycl Hyc Tab 200mg Dr","code_information":[{"code":"CP17744631829745742","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547032506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830870760","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010002803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Dorzol/timol Sol 2-0.5%op","code_information":[{"code":"CP17744631829729491","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829726176","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829785661","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603018510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829780893","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Enoxaparin   Inj 60/0.6ml","code_information":[{"code":"CP17744631829783963","type":"CDM"},{"code":"250","type":"RC"},{"code":"81952012626","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Epinephrine  Sol 10/10ml","code_information":[{"code":"CP17744631829794448","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288012301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Fluvoxamine  Cap 150mg Er","code_information":[{"code":"CP17744631829985227","type":"CDM"},{"code":"250","type":"RC"},{"code":"22828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Haloper Dec  Inj 50mg/ml","code_information":[{"code":"CP17744631830069646","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hc/acet Acid Sol Otic","code_information":[{"code":"CP17744631830079792","type":"CDM"},{"code":"250","type":"RC"},{"code":"71656006410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hollister Wafer #14309","code_information":[{"code":"CP17744631830081889","type":"CDM"},{"code":"250","type":"RC"},{"code":"11111014309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":6,"maximum":7,"gross_charge":7,"discounted_cash":7,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":7},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Douche/enema Mis Wtr Btle","code_information":[{"code":"CP17744631829720467","type":"CDM"},{"code":"250","type":"RC"},{"code":"49022000417","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Asenapine    Sub 2.5mg","code_information":[{"code":"CP17744631828761884","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991092860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pirfenidone  Tab 267mg","code_information":[{"code":"CP17744631830780835","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729046785","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":267,"type":"ME"}},{"description":"Stocking K-h 2xl 18mmhg","code_information":[{"code":"CP17744631831069953","type":"CDM"},{"code":"250","type":"RC"},{"code":"3870393008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking Knee High 18mmhg","code_information":[{"code":"CP17744631831073160","type":"CDM"},{"code":"250","type":"RC"},{"code":"3870393008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"T.e.d. Stocking 2xl","code_information":[{"code":"CP17744631831094509","type":"CDM"},{"code":"250","type":"RC"},{"code":"71776800000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 40/0.4ml","code_information":[{"code":"CP17744631829784801","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Methylp Ss 40mg/50ml Ns","code_information":[{"code":"CP17744631830449562","type":"CDM"},{"code":"250","type":"RC"},{"code":"90039","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Methylpred 60mg/50ml Ns 0.9%","code_information":[{"code":"CP17744631830455729","type":"CDM"},{"code":"250","type":"RC"},{"code":"90039","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Methylpred Ss 40mg/50ml 0.9%ns","code_information":[{"code":"CP17744631830454087","type":"CDM"},{"code":"250","type":"RC"},{"code":"90039","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pot Chloride Sol 10%","code_information":[{"code":"CP17744631830799309","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571035707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Solu-medrol  Inj 40mg","code_information":[{"code":"CP17744631831053399","type":"CDM"},{"code":"250","type":"RC"},{"code":"90039","type":"CPT","modifier":"28"}],"standard_charges":[{"setting":"outpatient","modifier_code":["28"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluconazole  Tab 200mg","code_information":[{"code":"CP17744631829960534","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Heparin Sod  Inj 20000/ml","code_information":[{"code":"CP17744631830077203","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739098625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20000,"type":"EA"}},{"description":"Nafcillin    Inj 2gm","code_information":[{"code":"CP17744631830530236","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860011726","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Acitretin    Cap 10mg","code_information":[{"code":"CP17744631828325575","type":"CDM"},{"code":"250","type":"RC"},{"code":"11517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Docosanol    Cre 10%","code_information":[{"code":"CP17744631829717056","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830216635","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714019601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Orajel 3x    Gel Tooth/gu","code_information":[{"code":"CP17744631830698994","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310028313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Orajel Max/str Gel Bns 0.","code_information":[{"code":"CP17744631830696048","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310028313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sock Knee High Lg 15-20","code_information":[{"code":"CP17744631831039118","type":"CDM"},{"code":"250","type":"RC"},{"code":"5113121592","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lantus       Inj 100/ml","code_information":[{"code":"CP17744631830226392","type":"CDM"},{"code":"250","type":"RC"},{"code":"88222","type":"CPT","modifier":"33"}],"standard_charges":[{"setting":"outpatient","modifier_code":["33"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Lantus 100 Units/ml Mdv 10 Ml","code_information":[{"code":"CP17744631830229656","type":"CDM"},{"code":"250","type":"RC"},{"code":"88222","type":"CPT","modifier":"33"}],"standard_charges":[{"setting":"outpatient","modifier_code":["33"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Lantus 100unit/ml Inj","code_information":[{"code":"CP17744631830229486","type":"CDM"},{"code":"250","type":"RC"},{"code":"88222","type":"CPT","modifier":"33"}],"standard_charges":[{"setting":"outpatient","modifier_code":["33"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Siklos       Tab 100mg","code_information":[{"code":"CP17744631831011426","type":"CDM"},{"code":"250","type":"RC"},{"code":"71770010560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Bd Nexiva    Mis 22gx1\"","code_information":[{"code":"CP17744631828848707","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290383512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bd Nexiva    Mis 24gx0.75","code_information":[{"code":"CP17744631828841877","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290383511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Halog        Sol 0.1%","code_information":[{"code":"CP17744631830060054","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631009510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nexiva 24gx0.75\" Iv Cath Syst","code_information":[{"code":"CP17744631830552032","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290383511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 5mg Odt","code_information":[{"code":"CP17744631830660920","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine   Tab 5mg Odt","code_information":[{"code":"CP17744631830668875","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine Odt 5mg","code_information":[{"code":"CP17744631830676077","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine Odt 5mg Tabs","code_information":[{"code":"CP17744631830678259","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zolpidem Er  Tab 6.25mg","code_information":[{"code":"CP17744631831419977","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335030788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Oxycodone    Tab 5mg","code_information":[{"code":"CP17744631830716310","type":"CDM"},{"code":"250","type":"RC"},{"code":"40605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pataday      Sol 0.2%","code_information":[{"code":"CP17744631830740468","type":"CDM"},{"code":"250","type":"RC"},{"code":"65815","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Gillette Razors Sensitive","code_information":[{"code":"CP17744631830035232","type":"CDM"},{"code":"250","type":"RC"},{"code":"47400004474","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830710941","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Seroquel     Tab 50mg","code_information":[{"code":"CP17744631831001203","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Verapamil    Cap 360mg Sr","code_information":[{"code":"CP17744631831262749","type":"CDM"},{"code":"250","type":"RC"},{"code":"59128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Cortizone-10 Gel Cooling","code_information":[{"code":"CP17744631829421300","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167000362","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Dextroamphet Tab 15mg","code_information":[{"code":"CP17744631829589095","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536051503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Miconazole 3 200mg-2% Pack","code_information":[{"code":"CP17744631830471851","type":"CDM"},{"code":"250","type":"RC"},{"code":"90454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Miconazole 3 Kit Combo Pk","code_information":[{"code":"CP17744631830478547","type":"CDM"},{"code":"250","type":"RC"},{"code":"90454","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clarinex-d   Tab 2.5-120","code_information":[{"code":"CP17744631829242086","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Ferrlecit    Inj 12.5mg/m","code_information":[{"code":"CP17744631829864764","type":"CDM"},{"code":"250","type":"RC"},{"code":"24279","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Naproxen Cr 375mg Tabs","code_information":[{"code":"CP17744631830540181","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781015301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Fentanyl     Dis 25mcg/hr","code_information":[{"code":"CP17744631829859170","type":"CDM"},{"code":"250","type":"RC"},{"code":"40691","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Huber Infusion Safestep","code_information":[{"code":"CP17744631830080135","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308","type":"CPT","modifier":"8"}],"standard_charges":[{"setting":"outpatient","modifier_code":["8"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine Sul Cap 45mg Er","code_information":[{"code":"CP17744631830502036","type":"CDM"},{"code":"250","type":"RC"},{"code":"22831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Oxandrolone  Tab 10mg","code_information":[{"code":"CP17744631830700228","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884030202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Griseofulvin Tab Micr 500","code_information":[{"code":"CP17744631830059776","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794001208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830815895","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830829135","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pregabalin-150mg-caps","code_information":[{"code":"CP17744631830829980","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin-25mg-caps","code_information":[{"code":"CP17744631830828530","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Zenpep       Cap 15000unt","code_information":[{"code":"CP17744631831398927","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":15000,"type":"EA"}},{"description":"Mitigare     Cap 0.6mg","code_information":[{"code":"CP17744631830496555","type":"CDM"},{"code":"250","type":"RC"},{"code":"59467031830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Mitigare     Cap 0.6mg","code_information":[{"code":"CP17744631830492498","type":"CDM"},{"code":"250","type":"RC"},{"code":"59467031801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Oxycontin    Tab 10mg Er","code_information":[{"code":"CP17744631830716963","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycontin 10mg Tabs","code_information":[{"code":"CP17744631830727696","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycontin Er 10mg Tabs","code_information":[{"code":"CP17744631830722230","type":"CDM"},{"code":"250","type":"RC"},{"code":"59011041020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cardizem La  Tab 360mg","code_information":[{"code":"CP17744631829127799","type":"CDM"},{"code":"250","type":"RC"},{"code":"18720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828383289","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Hc/acet Acid Sol 1-2%otic","code_information":[{"code":"CP17744631830074148","type":"CDM"},{"code":"250","type":"RC"},{"code":"71308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 10mg Odt","code_information":[{"code":"CP17744631830666340","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 10mg Odt","code_information":[{"code":"CP17744631830669580","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine Odt 10mg Tabs","code_information":[{"code":"CP17744631830673849","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole  Tab 10mg Odt","code_information":[{"code":"CP17744631828746983","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332010330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole  Tab 15mg Odt","code_information":[{"code":"CP17744631828746951","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332010430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aripiprazole Odt 10mg","code_information":[{"code":"CP17744631828744374","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452033813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg Odt","code_information":[{"code":"CP17744631828749111","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578010678","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg Odt","code_information":[{"code":"CP17744631828742923","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332010330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg Odt","code_information":[{"code":"CP17744631828747806","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452033813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 15mg Odt","code_information":[{"code":"CP17744631828740770","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332010430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aripiprazole Tab 15mg Odt","code_information":[{"code":"CP17744631828747619","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578010706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Cerefolin    Tab Nac","code_information":[{"code":"CP17744631829197231","type":"CDM"},{"code":"250","type":"RC"},{"code":"52505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tubigrip Bandage 3 &1/2\"","code_information":[{"code":"CP17744631831191847","type":"CDM"},{"code":"250","type":"RC"},{"code":"33255144934","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tubigrip Size F 4\"x1 Yard","code_information":[{"code":"CP17744631831195752","type":"CDM"},{"code":"250","type":"RC"},{"code":"68372","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mesalamine   Sup 1000mg","code_information":[{"code":"CP17744631830437043","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722000530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Mesalamine   Sup 1000mg","code_information":[{"code":"CP17744631830433774","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918056030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Clobazam     Tab 20mg","code_information":[{"code":"CP17744631829265747","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238130601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Diclofenac   Sol 2%","code_information":[{"code":"CP17744631829591728","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180053701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Diltiazem    Cap 120mg Er","code_information":[{"code":"CP17744631829685897","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714055501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Diltiazem Er 12hr 120mg Cap","code_information":[{"code":"CP17744631829697651","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714055501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Pirfenidone  Cap 267mg","code_information":[{"code":"CP17744631830782507","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219164207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":267,"type":"ME"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829784677","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505079504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Epinephrine  Inj 1mg/ml","code_information":[{"code":"CP17744631829795989","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288012001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831057170","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Carvedilol   Cap 20mg Er","code_information":[{"code":"CP17744631829133758","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505367903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Durapore 1\"x10yd","code_information":[{"code":"CP17744631829763447","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333153801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829788068","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603020510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829787773","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288041089","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lidocaine    Inj 1%","code_information":[{"code":"CP17744631830330629","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/hc  Sus 1% Otic","code_information":[{"code":"CP17744631830540200","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venlafaxine Er 225mg Tabs","code_information":[{"code":"CP17744631831261142","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Voriconazole Tab 50mg","code_information":[{"code":"CP17744631831300742","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547037703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dextroamphet Tab 30mg","code_information":[{"code":"CP17744631829584624","type":"CDM"},{"code":"250","type":"RC"},{"code":"75826012610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Freestyle    Liq Control","code_information":[{"code":"CP17744631830008981","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073014002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocellular Pad 4x4 N-a","code_information":[{"code":"CP17744631830096903","type":"CDM"},{"code":"250","type":"RC"},{"code":"93037","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cervical     Mis Collar","code_information":[{"code":"CP17744631829201961","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601087300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neevo Dha    Cap 27-1.13","code_information":[{"code":"CP17744631830545595","type":"CDM"},{"code":"250","type":"RC"},{"code":"52503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":27,"type":"EA"}},{"description":"Ampicillin/sulb 3 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828524934","type":"CDM"},{"code":"250","type":"RC"},{"code":"40929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Lansopr/amox Pak /Clarith","code_information":[{"code":"CP17744631830215333","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Skin Barrier Waf 57mm","code_information":[{"code":"CP17744631831023583","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380014506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amitiza      Cap 24mcg","code_information":[{"code":"CP17744631828472201","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764024060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Amitiza      Cap 8mcg","code_information":[{"code":"CP17744631828477806","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764008060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Amitiza 8mcg Caps","code_information":[{"code":"CP17744631828472232","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764008060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Amitiza-24mcg-caps","code_information":[{"code":"CP17744631828479690","type":"CDM"},{"code":"250","type":"RC"},{"code":"64764024060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Clindamycin  Gel Tretinoi","code_information":[{"code":"CP17744631829254573","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993095931","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxandrolone  Tab 10mg","code_information":[{"code":"CP17744631830704443","type":"CDM"},{"code":"250","type":"RC"},{"code":"24502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Topiramate   Cap Er 200mg","code_information":[{"code":"CP17744631831155725","type":"CDM"},{"code":"250","type":"RC"},{"code":"83210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"B-complex    Inj 100","code_information":[{"code":"CP17744631828846768","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457014630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829783493","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venlafaxine  Tab 112.5mg","code_information":[{"code":"CP17744631831252503","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427063230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1125,"type":"ME"}},{"description":"Venlafaxine Bes Er-112.5m Tb24","code_information":[{"code":"CP17744631831265077","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427063230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830339666","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291049530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 20mg Odt","code_information":[{"code":"CP17744631830669411","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746030932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine    Tab 20mg Odt","code_information":[{"code":"CP17744631830665032","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine   Tab 20mg Odt","code_information":[{"code":"CP17744631830666055","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine   Tab 20mg Odt","code_information":[{"code":"CP17744631830669982","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746030932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine Odt 20mg Tabs","code_information":[{"code":"CP17744631830677347","type":"CDM"},{"code":"250","type":"RC"},{"code":"93524","type":"CPT","modifier":"865"}],"standard_charges":[{"setting":"outpatient","modifier_code":["865"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine Odt 20mg Tabs","code_information":[{"code":"CP17744631830670518","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862065903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine Odt 20mg Tabs","code_information":[{"code":"CP17744631830675985","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Brimo/timolo Sol 0.2/0.5%","code_information":[{"code":"CP17744631828943429","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462028169","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Scalpicin    Sol 1%","code_information":[{"code":"CP17744631830997677","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824085015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carbamazepin Cap 300mg Er","code_information":[{"code":"CP17744631829116978","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993040932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830991058","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802058046","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Scopolamine 1mg/3days Patch","code_information":[{"code":"CP17744631830990652","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802058046","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bystolic     Tab 10mg","code_information":[{"code":"CP17744631829051805","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bystolic     Tab 5mg","code_information":[{"code":"CP17744631829059464","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bystolic 5mg Tabs","code_information":[{"code":"CP17744631829059245","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Esomeprazole Gra 40mg Dr","code_information":[{"code":"CP17744631829810814","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382084994","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Zithromax    Inj 500mg","code_information":[{"code":"CP17744631831401544","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315","type":"CPT","modifier":"83"}],"standard_charges":[{"setting":"outpatient","modifier_code":["83"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tenofovir    Tab 300mg","code_information":[{"code":"CP17744631831111555","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380071404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Tenofovir 300mg Tabs","code_information":[{"code":"CP17744631831117793","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pentasa      Cap 500mg Cr","code_information":[{"code":"CP17744631830747565","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092019112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Proctofoam   Aer Ns 1%","code_information":[{"code":"CP17744631830831307","type":"CDM"},{"code":"250","type":"RC"},{"code":"37682","type":"CPT","modifier":"315"}],"standard_charges":[{"setting":"outpatient","modifier_code":["315"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sucralfate   Tab 1gm","code_information":[{"code":"CP17744631831073658","type":"CDM"},{"code":"250","type":"RC"},{"code":"93221","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Sucralfate 1gm Tabs","code_information":[{"code":"CP17744631831076299","type":"CDM"},{"code":"250","type":"RC"},{"code":"93221","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Mepilex Border 4x4","code_information":[{"code":"CP17744631830428324","type":"CDM"},{"code":"250","type":"RC"},{"code":"73107929530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mepilex Foam Drs 4x4","code_information":[{"code":"CP17744631830420306","type":"CDM"},{"code":"250","type":"RC"},{"code":"38318294199","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 20mg Odt","code_information":[{"code":"CP17744631830667949","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine   Tab 20mg Odt","code_information":[{"code":"CP17744631830660074","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine Odt 20mg Tabs","code_information":[{"code":"CP17744631830679958","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Aquacel Foam 4\"x4\" Pads","code_information":[{"code":"CP17744631828733391","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aquacel Foam Pad 4\"x4\"","code_information":[{"code":"CP17744631828734101","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cardura      Tab 1mg","code_information":[{"code":"CP17744631829121760","type":"CDM"},{"code":"250","type":"RC"},{"code":"49241","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Phexxi       Gel","code_information":[{"code":"CP17744631830760235","type":"CDM"},{"code":"250","type":"RC"},{"code":"69751010012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol    Dis 0.025mg","code_information":[{"code":"CP17744631829811842","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydroco/apap Tab 10-325mg","code_information":[{"code":"CP17744631830101634","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386035801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831134802","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Daytrana     Dis 15mg/9hr","code_information":[{"code":"CP17744631829540125","type":"CDM"},{"code":"250","type":"RC"},{"code":"68968555303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830219081","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine 200mg Odt","code_information":[{"code":"CP17744631830218432","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Bacit/polymy Oin Op","code_information":[{"code":"CP17744631828825275","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bacitracin/polymyxin B Eyeoint","code_information":[{"code":"CP17744631828822034","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bimatoprost  Sol 0.03% Op","code_information":[{"code":"CP17744631828884822","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571012835","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Erythromycin 5mg/gm Oint","code_information":[{"code":"CP17744631829806781","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Erythromycin Oin 5mg/gm","code_information":[{"code":"CP17744631829809116","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Erythromycin Oin Op","code_information":[{"code":"CP17744631829808830","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 20mg Odt","code_information":[{"code":"CP17744631830666839","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668009030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine   Tab 20mg Odt","code_information":[{"code":"CP17744631830669472","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668009030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine Odt 20mg Tabs","code_information":[{"code":"CP17744631830673897","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668009030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Paliperidone Er 1.5mg Tabs","code_information":[{"code":"CP17744631830721550","type":"CDM"},{"code":"250","type":"RC"},{"code":"10147095103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pill Box Am/noon/pm/bed","code_information":[{"code":"CP17744631830772885","type":"CDM"},{"code":"250","type":"RC"},{"code":"2318547435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pill Crusher Mis","code_information":[{"code":"CP17744631830771197","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917014564","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sildenafil   Tab 20mg","code_information":[{"code":"CP17744631831016813","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162035109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sildenafil Solution","code_information":[{"code":"CP17744631831014403","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162035109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thermalon Dry Eye Compres","code_information":[{"code":"CP17744631831124147","type":"CDM"},{"code":"250","type":"RC"},{"code":"4153324347","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adapalene    Gel 0.3%","code_information":[{"code":"CP17744631828341692","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828384211","type":"CDM"},{"code":"250","type":"RC"},{"code":"37882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829108042","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714046801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830495318","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862060201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Modafinil 200mg Tabs","code_information":[{"code":"CP17744631830492555","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862060201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830659522","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prezista     Sus 100mg/ml","code_information":[{"code":"CP17744631830833706","type":"CDM"},{"code":"250","type":"RC"},{"code":"59676056501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Timolol Mal  Sol 0.25% Op","code_information":[{"code":"CP17744631831137850","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742028760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Timolol Maleate-0.25% Pf","code_information":[{"code":"CP17744631831138745","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742028760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ceftazadime 2g/100ml El-j","code_information":[{"code":"CP17744631829176968","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime  Inj 2gm","code_information":[{"code":"CP17744631829178387","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime 2gm/100ml Ns","code_information":[{"code":"CP17744631829176455","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime 2gm/50ml Ns","code_information":[{"code":"CP17744631829172560","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Metronidazol Cap 375mg","code_information":[{"code":"CP17744631830479283","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332001850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830499693","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505252703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pill Crusher Metal S/k","code_information":[{"code":"CP17744631830777646","type":"CDM"},{"code":"250","type":"RC"},{"code":"10263061026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Colesevelam  Tab 625mg","code_information":[{"code":"CP17744631829404791","type":"CDM"},{"code":"250","type":"RC"},{"code":"71309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Glargin Yfgn Sol 100u/ml","code_information":[{"code":"CP17744631830035109","type":"CDM"},{"code":"250","type":"RC"},{"code":"83257001411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830540001","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 20mg","code_information":[{"code":"CP17744631830660386","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine 20mg Tabs","code_information":[{"code":"CP17744631830673352","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Chlord/clidi Cap 5-2.5mg","code_information":[{"code":"CP17744631829210314","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494040901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chlord/clidi Cap 5-2.5mg","code_information":[{"code":"CP17744631829216613","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219167701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Knee Supprt Elastic","code_information":[{"code":"CP17744631830197375","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Astagraf Xl  Cap 1mg","code_information":[{"code":"CP17744631828774431","type":"CDM"},{"code":"250","type":"RC"},{"code":"46906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Macrobid     Cap 100mg","code_information":[{"code":"CP17744631830394149","type":"CDM"},{"code":"250","type":"RC"},{"code":"52427028501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Renvela      Tab 800mg","code_information":[{"code":"CP17744631830882368","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468013301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Renvela      Tab 800mg","code_information":[{"code":"CP17744631830888085","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468013001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Renvela 800mg Tabs","code_information":[{"code":"CP17744631830884449","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468013001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Renvela-800mg-tabs","code_information":[{"code":"CP17744631830886744","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468013001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Segluromet   Tab 2.5-1000","code_information":[{"code":"CP17744631830998275","type":"CDM"},{"code":"250","type":"RC"},{"code":"65373","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Segluromet   Tab 7.5-1000","code_information":[{"code":"CP17744631830990515","type":"CDM"},{"code":"250","type":"RC"},{"code":"65374","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Trimethobenz Cap 300mg","code_information":[{"code":"CP17744631831196860","type":"CDM"},{"code":"250","type":"RC"},{"code":"53489037601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Dextroamphet Tab 20mg","code_information":[{"code":"CP17744631829581726","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536052003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Anusol-hc    Cre 2.5%","code_information":[{"code":"CP17744631828721998","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649040130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Chloraseptic Spr 1.4%","code_information":[{"code":"CP17744631829210449","type":"CDM"},{"code":"250","type":"RC"},{"code":"78112001103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":14,"type":"EA"}},{"description":"Chloraseptic Spr Max","code_information":[{"code":"CP17744631829215549","type":"CDM"},{"code":"250","type":"RC"},{"code":"78112000068","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epump Set    Mis 1000ml","code_information":[{"code":"CP17744631829799842","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080773662","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Meropenem 2gm/100ml Kit","code_information":[{"code":"CP17744631830420704","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567040201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Meropenem 2gm/100ml Ns Mb+","code_information":[{"code":"CP17744631830424536","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567040201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Morphine Sul Cap 60mg Er","code_information":[{"code":"CP17744631830504173","type":"CDM"},{"code":"250","type":"RC"},{"code":"83202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Natura Dura  Waf 70mm","code_information":[{"code":"CP17744631830545860","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012394","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Natura+ Clos Mis 2-3/4\"","code_information":[{"code":"CP17744631830543918","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455011330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Polyeth Glyc Pow 3350 Nf","code_information":[{"code":"CP17744631830782909","type":"CDM"},{"code":"250","type":"RC"},{"code":"11534018028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Salicylic Ac Gel 6%","code_information":[{"code":"CP17744631830924549","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192013440","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Sharp Container 5qt","code_information":[{"code":"CP17744631831010211","type":"CDM"},{"code":"250","type":"RC"},{"code":"99510085075","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sharp Container 5qt--mis","code_information":[{"code":"CP17744631831017573","type":"CDM"},{"code":"250","type":"RC"},{"code":"99510085075","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/atorva Tab 10-40mg","code_information":[{"code":"CP17744631828484178","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505348903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Visbiome     Pak","code_information":[{"code":"CP17744631831270913","type":"CDM"},{"code":"250","type":"RC"},{"code":"69355051601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Visbiome Pak","code_information":[{"code":"CP17744631831277357","type":"CDM"},{"code":"250","type":"RC"},{"code":"69355051601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830530467","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Naloxone 0.4mg/ml Soln","code_information":[{"code":"CP17744631830539574","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Stockign K-h Medium 15-20","code_information":[{"code":"CP17744631831063603","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189059655","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking K-h Large 15-20","code_information":[{"code":"CP17744631831067876","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318959656","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Filtered Ext Set 0.2mi","code_information":[{"code":"CP17744631830176371","type":"CDM"},{"code":"250","type":"RC"},{"code":"8021473989","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Salicylic Ac Liq 27.5%","code_information":[{"code":"CP17744631830920308","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192013510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":275,"type":"EA"}},{"description":"Xanax        Tab 0.25mg","code_information":[{"code":"CP17744631831388751","type":"CDM"},{"code":"250","type":"RC"},{"code":"90029","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lorazepam 1mg/ml Top Gel","code_information":[{"code":"CP17744631830360904","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552072904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Capecitabine 500mg Tabs","code_information":[{"code":"CP17744631829107648","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729007329","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829101021","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651020508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829100261","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729007329","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829108122","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756081622","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clobazam     Tab 20mg","code_information":[{"code":"CP17744631829268573","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Compression Stockings","code_information":[{"code":"CP17744631829410673","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290007604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diazoxide    Sus 50mg/ml","code_information":[{"code":"CP17744631829586070","type":"CDM"},{"code":"250","type":"RC"},{"code":"13517010030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Diazoxide Susp 50mg/ml 30ml","code_information":[{"code":"CP17744631829589749","type":"CDM"},{"code":"250","type":"RC"},{"code":"13517010030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Heparin Sod  Inj 5000/0.5","code_information":[{"code":"CP17744631830077423","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323011805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Hose T.e.d. Xl-rg Hos Cur","code_information":[{"code":"CP17744631830085694","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290007604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phos-nak     Pow Concentr","code_information":[{"code":"CP17744631830763851","type":"CDM"},{"code":"250","type":"RC"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phos-nak 250-160-280 Pow Pack","code_information":[{"code":"CP17744631830761835","type":"CDM"},{"code":"250","type":"RC"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Phos-nak Powder Packets","code_information":[{"code":"CP17744631830766785","type":"CDM"},{"code":"250","type":"RC"},{"code":"60258000601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Progesterone Sup Vgs 100","code_information":[{"code":"CP17744631830832948","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628006201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829100242","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877045912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Aquacel Foam 4\"x4\" Pads","code_information":[{"code":"CP17744631828739643","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012336","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aquacel Foam Pad 4\"x4\"","code_information":[{"code":"CP17744631828737024","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455012336","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carvedilol   Cap 20mg Er","code_information":[{"code":"CP17744631829133354","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505471403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Digoxin      Tab 0.0625mg","code_information":[{"code":"CP17744631829602636","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651043601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Digoxin      Tab 62.5mcg","code_information":[{"code":"CP17744631829608911","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651043601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Digoxin 62.5mcg Tab","code_information":[{"code":"CP17744631829603503","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651043601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Nozin Nasal  Mis Sanitize","code_information":[{"code":"CP17744631830649700","type":"CDM"},{"code":"250","type":"RC"},{"code":"56923001122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 50mcg/hr","code_information":[{"code":"CP17744631829853488","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pioglit/glim Tab 30-2mg","code_information":[{"code":"CP17744631830772339","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993082130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Prednisolone  Tab 10mg Odt","code_information":[{"code":"CP17744631830816152","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993084435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prednisolone Tab 10mg Odt","code_information":[{"code":"CP17744631830816785","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993084435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Synjardy     Tab 12.5-500","code_information":[{"code":"CP17744631831085124","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Synjardy     Tab 5-1000mg","code_information":[{"code":"CP17744631831085913","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Synjardy 5/1000mg Tabs","code_information":[{"code":"CP17744631831087039","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Synjardy Xr Tab 12.5-1000mg","code_information":[{"code":"CP17744631831081407","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Carvedilol   Cap 40mg Er","code_information":[{"code":"CP17744631829130019","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714022901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Bystolic     Tab 20mg","code_information":[{"code":"CP17744631829054864","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Bystolic 20mg Tabs","code_information":[{"code":"CP17744631829059014","type":"CDM"},{"code":"250","type":"RC"},{"code":"45614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Skin Barrier Waf 70mm","code_information":[{"code":"CP17744631831021937","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380014604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lansoprazole Pow","code_information":[{"code":"CP17744631830219624","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779228904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830996763","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802058062","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Acitretin    Cap 25mg","code_information":[{"code":"CP17744631828322893","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794008308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ampicillin/sulb 3 Gm/100ml Mb","code_information":[{"code":"CP17744631828523201","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Eliquis St P Tab 5mg","code_information":[{"code":"CP17744631829770327","type":"CDM"},{"code":"250","type":"RC"},{"code":"33764","type":"CPT","modifier":"74"}],"standard_charges":[{"setting":"outpatient","modifier_code":["74"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alocane Max St 4% Gel","code_information":[{"code":"CP17744631828430875","type":"CDM"},{"code":"250","type":"RC"},{"code":"46241000646","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alocane Max Strength Gel","code_information":[{"code":"CP17744631828435449","type":"CDM"},{"code":"250","type":"RC"},{"code":"46241000646","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azathioprine Tab 75mg","code_information":[{"code":"CP17744631828805242","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219203601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cefazolin 3 Gm/100 Ml Mb+","code_information":[{"code":"CP17744631829157195","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefazolin 3gm/100ml Ns","code_information":[{"code":"CP17744631829154810","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefazolin 6g/250ml Ns","code_information":[{"code":"CP17744631829158205","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":6,"type":"GR"}},{"description":"Cefazolin 6g/480ml Xel","code_information":[{"code":"CP17744631829159846","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":6,"type":"GR"}},{"description":"Compression Socks Kh S/m","code_information":[{"code":"CP17744631829413231","type":"CDM"},{"code":"250","type":"RC"},{"code":"12306","type":"CPT","modifier":"40"}],"standard_charges":[{"setting":"outpatient","modifier_code":["40"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Latex Gloveslg","code_information":[{"code":"CP17744631830226955","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784023389","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cipro        Tab 500mg","code_information":[{"code":"CP17744631829237280","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419075401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Mesalamine   Sup 1000mg","code_information":[{"code":"CP17744631830431924","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762011803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Mesalamine   Sup 1000mg","code_information":[{"code":"CP17744631830430928","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980028203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Fenofibrate  Cap 150mg","code_information":[{"code":"CP17744631829853876","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559046190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Ivermectin   Cre 1%","code_information":[{"code":"CP17744631830174135","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802010284","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Saxagliptin  Tab 2.5mg","code_information":[{"code":"CP17744631830998173","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462072630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Benadryl/mylanta/lidcaine","code_information":[{"code":"CP17744631828859594","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clobazam     Tab 20mg","code_information":[{"code":"CP17744631829262497","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571031601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Compact Spac Mis Chamber","code_information":[{"code":"CP17744631829413138","type":"CDM"},{"code":"250","type":"RC"},{"code":"42135010000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexa/lidocaine/diphen","code_information":[{"code":"CP17744631829575522","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epinastine   Dro 0.05%","code_information":[{"code":"CP17744631829791820","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991083675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Geri-lanta/lidocaine/diphen","code_information":[{"code":"CP17744631830032870","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iodoform Gauze Strip 1/4\"","code_information":[{"code":"CP17744631830153007","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784034112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Latanoprost  Sol 0.005%","code_information":[{"code":"CP17744631830225818","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980051625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Latanoprost  Sol 0.005%","code_information":[{"code":"CP17744631830220245","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314054703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Licocain/mylanta/diphen/nystat","code_information":[{"code":"CP17744631830323486","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lid/ant/dip/nys/dex 1:1:1:1:1","code_information":[{"code":"CP17744631830326096","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidogeri-lantadiphenhyd","code_information":[{"code":"CP17744631830327029","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido Viscgerilantadiphen","code_information":[{"code":"CP17744631830329406","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido Viscmylantadiphen","code_information":[{"code":"CP17744631830326395","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido Visc/nystat/diphen/mag-al","code_information":[{"code":"CP17744631830328010","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido Visc-diphen-mylanta-nysta","code_information":[{"code":"CP17744631830324562","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido Visc-phenohytro-diphenhyd","code_information":[{"code":"CP17744631830322794","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain/alum/magn/sime/diph","code_information":[{"code":"CP17744631830326034","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain/mylanta/diphen/nystat","code_information":[{"code":"CP17744631830320576","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Sol 2% Oral","code_information":[{"code":"CP17744631830333886","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lidocaine 2% / Diphen / Ant","code_information":[{"code":"CP17744631830339102","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 2% /Diphenhydram/ant","code_information":[{"code":"CP17744631830330669","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine Viscmylanta","code_information":[{"code":"CP17744631830330019","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine/maalox/diphen","code_information":[{"code":"CP17744631830349784","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine2%/mylan/ Benad/nysta","code_information":[{"code":"CP17744631830348281","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine2%/mylanta/benadryl","code_information":[{"code":"CP17744631830345337","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine2%/mylanta/hyosyine","code_information":[{"code":"CP17744631830342778","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido-diphen-almacone 1-1-1","code_information":[{"code":"CP17744631830345856","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido-diphen-geri-lanta 1-1-1","code_information":[{"code":"CP17744631830349347","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido-diphen-maalox 1-1-1","code_information":[{"code":"CP17744631830347937","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Maalox/lidocaine 2%","code_information":[{"code":"CP17744631830393079","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ceftazidime  Inj 2gm","code_information":[{"code":"CP17744631829170586","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime 2gm / D5w 50ml","code_information":[{"code":"CP17744631829176104","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime 2gm/100ml Ns","code_information":[{"code":"CP17744631829172520","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime 2gm/50ml D5w","code_information":[{"code":"CP17744631829179973","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftazidime 2gm/50ml Ns Mb+","code_information":[{"code":"CP17744631829175928","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Bryhali      Lot 0.01%","code_information":[{"code":"CP17744631828951245","type":"CDM"},{"code":"250","type":"RC"},{"code":"18700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Darunavir    Tab 600mg","code_information":[{"code":"CP17744631829549002","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651008560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Doxepin Hcl  Cre 5%","code_information":[{"code":"CP17744631829732168","type":"CDM"},{"code":"250","type":"RC"},{"code":"93960","type":"CPT","modifier":"995"}],"standard_charges":[{"setting":"outpatient","modifier_code":["995"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lurasidone   Tab 40mg","code_information":[{"code":"CP17744631830384365","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332049530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lurasidone   Tab 80mg","code_information":[{"code":"CP17744631830385725","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332049730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Darunavir    Tab 600mg","code_information":[{"code":"CP17744631829543862","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180034507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Duoderm Cgf  Mis 4\"x4\"","code_information":[{"code":"CP17744631829758250","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010270","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Sus 200/5ml","code_information":[{"code":"CP17744631828332195","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722068147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Cycloset     Tab 0.8mg","code_information":[{"code":"CP17744631829449830","type":"CDM"},{"code":"250","type":"RC"},{"code":"68012025820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Duoderm Sig  Mis 4\"x4\"","code_information":[{"code":"CP17744631829758282","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 250mg Er","code_information":[{"code":"CP17744631830211771","type":"CDM"},{"code":"250","type":"RC"},{"code":"22816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Polyvinyl Al Sol 1.4% Op","code_information":[{"code":"CP17744631830787900","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":14,"type":"EA"}},{"description":"Brinzolamide Sus 1% Op","code_information":[{"code":"CP17744631828954928","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nexcare Cold Mis Pack","code_information":[{"code":"CP17744631830551478","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131018413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pancreaze    Cap 16800unt","code_information":[{"code":"CP17744631830738243","type":"CDM"},{"code":"250","type":"RC"},{"code":"62541040410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":16800,"type":"EA"}},{"description":"Pantoprazole Pak 40mg","code_information":[{"code":"CP17744631830730742","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241025638","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Alog/pioglit Tab 25-30mg","code_information":[{"code":"CP17744631828439560","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802040265","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Octreotide   Inj 200mcg","code_information":[{"code":"CP17744631830653351","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Alogliptin   Tab 6.25mg","code_information":[{"code":"CP17744631828438198","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802008765","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Clotrim/beta Cre 1-0.05%","code_information":[{"code":"CP17744631829383160","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714049601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Divigel      Gel 1mg/gm","code_information":[{"code":"CP17744631829710728","type":"CDM"},{"code":"250","type":"RC"},{"code":"68025006730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Lotrisone/zinc Oxide 1:1","code_information":[{"code":"CP17744631830378876","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714049601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Emu 0.05%","code_information":[{"code":"CP17744631829442012","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702080803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Emu 0.05% Op","code_information":[{"code":"CP17744631829440985","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702080803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitrofurantn Sus 25mg/5ml","code_information":[{"code":"CP17744631830569054","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603017601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Breo Ellipta  100-25 (14 Inh)","code_information":[{"code":"CP17744631828946681","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta  100-25 (28 Inh)","code_information":[{"code":"CP17744631828940998","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Breo Ellipta Inh 100-25","code_information":[{"code":"CP17744631828943780","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cipro/dexa   Sus 0.3-0.1%","code_information":[{"code":"CP17744631829237137","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746083153","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Pataday      Sol 0.7%","code_information":[{"code":"CP17744631830746439","type":"CDM"},{"code":"250","type":"RC"},{"code":"65081","type":"CPT","modifier":"604"}],"standard_charges":[{"setting":"outpatient","modifier_code":["604"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":7,"type":"EA"}},{"description":"Potassium 20meq Powder Pack","code_information":[{"code":"CP17744631830799824","type":"CDM"},{"code":"250","type":"RC"},{"code":"60315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Efavirenz    Tab 600mg","code_information":[{"code":"CP17744631829760522","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862004930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Efavirenz 600mg Tabs","code_information":[{"code":"CP17744631829761740","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722050430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Duoderm Cgf  Mis 2.5\"x2.5","code_information":[{"code":"CP17744631829752393","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010283","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830216890","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamotrigine 100mg Odt","code_information":[{"code":"CP17744631830210834","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Haloper Lac  Inj 5mg/ml","code_information":[{"code":"CP17744631830062586","type":"CDM"},{"code":"250","type":"RC"},{"code":"10147091101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hear Aid Bat Mis Size 13","code_information":[{"code":"CP17744631830071172","type":"CDM"},{"code":"250","type":"RC"},{"code":"41333063287","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dartisla Odt Tab 1.7mg","code_information":[{"code":"CP17744631829541285","type":"CDM"},{"code":"250","type":"RC"},{"code":"82111051801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":17,"type":"ME"}},{"description":"Olanzapine   Tab 20mg","code_information":[{"code":"CP17744631830664908","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine   Tab 20mg","code_information":[{"code":"CP17744631830663350","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine   Tab 20mg","code_information":[{"code":"CP17744631830668085","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine 20mg Tabs","code_information":[{"code":"CP17744631830671929","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olanzapine 20mg Tabs","code_information":[{"code":"CP17744631830674492","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Desitin-13% Mylanta","code_information":[{"code":"CP17744631829566967","type":"CDM"},{"code":"250","type":"RC"},{"code":"19903001030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mylanta      Sus Tonight","code_information":[{"code":"CP17744631830528359","type":"CDM"},{"code":"250","type":"RC"},{"code":"19903001030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxymorphone  Tab 10mg Er","code_information":[{"code":"CP17744631830724771","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896069713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Riluzole     Tab 50mg","code_information":[{"code":"CP17744631830898546","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980019106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sod Chloride Inj 0.45%","code_information":[{"code":"CP17744631831045771","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Sodium Chloride 0.45% (500ml)","code_information":[{"code":"CP17744631831047049","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Ferrous Sulf Sol 300/5ml","code_information":[{"code":"CP17744631829869129","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328015705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ferrous Sulf Syp 300/5ml","code_information":[{"code":"CP17744631829865368","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328015705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Linezolid    Tab 600mg","code_information":[{"code":"CP17744631830344587","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762130701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Droxidopa    Cap 100mg","code_information":[{"code":"CP17744631829758315","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722001490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Droxidopa    Cap 100mg","code_information":[{"code":"CP17744631829753373","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436014006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Zubsolv      Sub 1.4-0.36","code_information":[{"code":"CP17744631831412482","type":"CDM"},{"code":"250","type":"RC"},{"code":"54123091430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":14,"type":"EA"}},{"description":"Lidorx       Gel 3%","code_information":[{"code":"CP17744631830341547","type":"CDM"},{"code":"250","type":"RC"},{"code":"35781030003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Cabergoline  Tab 0.5mg","code_information":[{"code":"CP17744631829058681","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742011808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cabergoline  Tab 0.5mg","code_information":[{"code":"CP17744631829052850","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155082373","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cabergoline  Tab 0.5mg","code_information":[{"code":"CP17744631829056763","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762100501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cabergoline  Tab 0.5mg","code_information":[{"code":"CP17744631829050745","type":"CDM"},{"code":"250","type":"RC"},{"code":"93542","type":"CPT","modifier":"88"}],"standard_charges":[{"setting":"outpatient","modifier_code":["88"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clonidine    Dis 0.1/24hr","code_information":[{"code":"CP17744631829370679","type":"CDM"},{"code":"250","type":"RC"},{"code":"59135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Janumet Xr   Tab 50-1000","code_information":[{"code":"CP17744631830173278","type":"CDM"},{"code":"250","type":"RC"},{"code":"60080","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Janumet Xr 24h 50-1000mg","code_information":[{"code":"CP17744631830176102","type":"CDM"},{"code":"250","type":"RC"},{"code":"60080","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Janumet Xr 50-1000mg Tabs","code_information":[{"code":"CP17744631830179068","type":"CDM"},{"code":"250","type":"RC"},{"code":"60080","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Knee High 15-20 Xxl","code_information":[{"code":"CP17744631830198112","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189587976","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking K-h 2xl 15-20","code_information":[{"code":"CP17744631831068107","type":"CDM"},{"code":"250","type":"RC"},{"code":"63189587976","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zovirax      Oin 5%","code_information":[{"code":"CP17744631831418170","type":"CDM"},{"code":"250","type":"RC"},{"code":"18709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5,"maximum":6,"gross_charge":6,"discounted_cash":6,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":6},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Brinzolamide Sus 1%","code_information":[{"code":"CP17744631828956874","type":"CDM"},{"code":"250","type":"RC"},{"code":"78160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clobazam 20mg Tabs","code_information":[{"code":"CP17744631829264054","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830104751","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367024324","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Iv Autoguard Wing 22x1","code_information":[{"code":"CP17744631830173879","type":"CDM"},{"code":"250","type":"RC"},{"code":"38152","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Autoguard Wing 24x0.75","code_information":[{"code":"CP17744631830174427","type":"CDM"},{"code":"250","type":"RC"},{"code":"38151","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupropion    Tab 150mg Xl","code_information":[{"code":"CP17744631828984019","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828991306","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Tenofovir    Tab 300mg","code_information":[{"code":"CP17744631831112430","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714082001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Diflorasone  Cre 0.05%","code_information":[{"code":"CP17744631829603568","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Quinapril    Tab 40mg","code_information":[{"code":"CP17744631830871121","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135048790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tylenol Chld Sus 160/5ml","code_information":[{"code":"CP17744631831206502","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580057902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Griseofulvin 500mg Tabs","code_information":[{"code":"CP17744631830056360","type":"CDM"},{"code":"250","type":"RC"},{"code":"78155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Griseofulvin Tab Micr 500","code_information":[{"code":"CP17744631830059566","type":"CDM"},{"code":"250","type":"RC"},{"code":"78155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Haloper Lac  Inj 5mg/ml","code_information":[{"code":"CP17744631830065564","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021080601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alum Hydrox  Sus 320/5ml","code_information":[{"code":"CP17744631828453662","type":"CDM"},{"code":"250","type":"RC"},{"code":"53600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Atropine Sul Inj 0.1mg/ml","code_information":[{"code":"CP17744631828793045","type":"CDM"},{"code":"250","type":"RC"},{"code":"40916","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fentanyl     Dis 50mcg/hr","code_information":[{"code":"CP17744631829853630","type":"CDM"},{"code":"250","type":"RC"},{"code":"40690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Spirometer","code_information":[{"code":"CP17744631831055227","type":"CDM"},{"code":"250","type":"RC"},{"code":"8884719009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thiamine 500mg/250ml Ns","code_information":[{"code":"CP17744631831128258","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ascor        Sol 25000mg","code_information":[{"code":"CP17744631828750512","type":"CDM"},{"code":"250","type":"RC"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25000,"type":"ME"}},{"description":"Ascorbid Acid Inj 25gm/250ml","code_information":[{"code":"CP17744631828765364","type":"CDM"},{"code":"250","type":"RC"},{"code":"67157010150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Calcitriol   Sol 1mcg/ml","code_information":[{"code":"CP17744631829066087","type":"CDM"},{"code":"250","type":"RC"},{"code":"54312","type":"CPT","modifier":"41"}],"standard_charges":[{"setting":"outpatient","modifier_code":["41"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dexamethason Tab 4mg","code_information":[{"code":"CP17744631829571920","type":"CDM"},{"code":"250","type":"RC"},{"code":"54418","type":"CPT","modifier":"425"}],"standard_charges":[{"setting":"outpatient","modifier_code":["425"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Dexamethasone 4mg Tabs","code_information":[{"code":"CP17744631829577578","type":"CDM"},{"code":"250","type":"RC"},{"code":"54418","type":"CPT","modifier":"425"}],"standard_charges":[{"setting":"outpatient","modifier_code":["425"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Letrozole    Tab 2.5mg","code_information":[{"code":"CP17744631830291266","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729003415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Phenazopyrid Tab 200mg","code_information":[{"code":"CP17744631830759579","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367061201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Olanzapine 20mg Tabs","code_information":[{"code":"CP17744631830674314","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Stocking K-h Xl 15-20","code_information":[{"code":"CP17744631831071512","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318959657","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cephalexin   Cap 750mg","code_information":[{"code":"CP17744631829195364","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025523","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Envarsus Xr  Tab 0.75mg","code_information":[{"code":"CP17744631829790166","type":"CDM"},{"code":"250","type":"RC"},{"code":"68992307503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pilocarpine  Sol 4% Op","code_information":[{"code":"CP17744631830774204","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314020615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Pilocarpine 4% Ophth Soln","code_information":[{"code":"CP17744631830770385","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314020615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Amox/clav Er 1000/62.5mg Tab","code_information":[{"code":"CP17744631828490353","type":"CDM"},{"code":"250","type":"RC"},{"code":"78119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Amox-pot Cla Tab Er","code_information":[{"code":"CP17744631828512840","type":"CDM"},{"code":"250","type":"RC"},{"code":"78119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexlansopraz Cap 30mg Dr","code_information":[{"code":"CP17744631829577657","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979070306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Dexlansopraz Cap 60mg Dr","code_information":[{"code":"CP17744631829575475","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979070407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Erythromycin Tab 500mg Bs","code_information":[{"code":"CP17744631829815358","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668060701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Imipram Pam  Cap 100mg","code_information":[{"code":"CP17744631830135278","type":"CDM"},{"code":"250","type":"RC"},{"code":"54027","type":"CPT","modifier":"413"}],"standard_charges":[{"setting":"outpatient","modifier_code":["413"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Metoclopramide Odt 5mg Tabs","code_information":[{"code":"CP17744631830450409","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386058131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Piper/tazoba Inj 4-0.5gm","code_information":[{"code":"CP17744631830780627","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Piper/tazobac  4.5g/100ml D5w","code_information":[{"code":"CP17744631830788850","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazobac 4.5g/100ml Ns","code_information":[{"code":"CP17744631830782808","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Monistat 3   Cre 4%","code_information":[{"code":"CP17744631830509309","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736044201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Am Sticker","code_information":[{"code":"CP17744631828450507","type":"CDM"},{"code":"250","type":"RC"},{"code":"11115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Erythromycin Tab 333mg Ec","code_information":[{"code":"CP17744631829807049","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238147201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":333,"type":"ME"}},{"description":"Hs Stickers","code_information":[{"code":"CP17744631830089397","type":"CDM"},{"code":"250","type":"RC"},{"code":"11117","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Leucovor Ca  Tab 10mg","code_information":[{"code":"CP17744631830294968","type":"CDM"},{"code":"250","type":"RC"},{"code":"54449","type":"CPT","modifier":"710"}],"standard_charges":[{"setting":"outpatient","modifier_code":["710"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tobramycin   Neb 300/4ml","code_information":[{"code":"CP17744631831143716","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603063056","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Muro 128     Oin 5% Op","code_information":[{"code":"CP17744631830528202","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208038555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":128,"type":"EA"}},{"description":"Doxepin      Tab 6mg","code_information":[{"code":"CP17744631829736248","type":"CDM"},{"code":"250","type":"RC"},{"code":"22833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Gentam/nacl  Inj 80mg","code_information":[{"code":"CP17744631830023159","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Gentamicin 80mg/100ml Ns","code_information":[{"code":"CP17744631830032674","type":"CDM"},{"code":"250","type":"RC"},{"code":"33805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Heel Protect Univ Sheep","code_information":[{"code":"CP17744631830075133","type":"CDM"},{"code":"250","type":"RC"},{"code":"75475635005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830821707","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332011990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pregabalin   Cap 50mg","code_information":[{"code":"CP17744631830826120","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin 50mg Caps","code_information":[{"code":"CP17744631830825990","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Xopenex Hfa  Aer","code_information":[{"code":"CP17744631831388165","type":"CDM"},{"code":"250","type":"RC"},{"code":"27437005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Antifungal   Cre 1%","code_information":[{"code":"CP17744631828720825","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001047547","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamterene  Cap 50mg","code_information":[{"code":"CP17744631831180126","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817036410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tussin Cough Liq Chest","code_information":[{"code":"CP17744631831203683","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399100406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tussin Cough/chest Dm Liqd","code_information":[{"code":"CP17744631831209408","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399100406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ferrous Sulf Sol 300/5ml","code_information":[{"code":"CP17744631829868487","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739015710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ferrous Sulf Syp 300/5ml","code_information":[{"code":"CP17744631829868384","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739015710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830774395","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729002215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Tirosint-sol Sol 112mcg","code_information":[{"code":"CP17744631831133903","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858013505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":112,"type":"ME"}},{"description":"Tirosint-sol Sol 13mcg/ml","code_information":[{"code":"CP17744631831134299","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858010505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":13,"type":"ME"}},{"description":"Tirosint-sol Sol 150mcg","code_information":[{"code":"CP17744631831132095","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858015005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Tirosint-sol Sol 200mcg","code_information":[{"code":"CP17744631831130430","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858016005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tirosint-sol Sol 37.5/ml","code_information":[{"code":"CP17744631831137660","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858011205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Tirosint-sol Sol 50mcg/ml","code_information":[{"code":"CP17744631831132938","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858011505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tirosint-sol Sol 62.5/ml","code_information":[{"code":"CP17744631831139116","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858011705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":625,"type":"EA"}},{"description":"Tirosint-sol Sol 75mcg/ml","code_information":[{"code":"CP17744631831131040","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858012005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Tirosint-sol Sol 88mcg/ml","code_information":[{"code":"CP17744631831132136","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858012505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"Elfolate     Tab 15mg","code_information":[{"code":"CP17744631829772368","type":"CDM"},{"code":"250","type":"RC"},{"code":"69206012090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Contrave     Tab 8-90mg","code_information":[{"code":"CP17744631829419322","type":"CDM"},{"code":"250","type":"RC"},{"code":"51267089099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Contrave Er 8-90mg Tabs","code_information":[{"code":"CP17744631829413008","type":"CDM"},{"code":"250","type":"RC"},{"code":"51267089099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Arginaid     Pak Orange","code_information":[{"code":"CP17744631828744714","type":"CDM"},{"code":"250","type":"RC"},{"code":"43900035980","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prograf      Gra 0.2mg","code_information":[{"code":"CP17744631830839328","type":"CDM"},{"code":"250","type":"RC"},{"code":"46912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Donut Cushion Inflatabl","code_information":[{"code":"CP17744631829721293","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601087020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830532873","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150032710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Prednisolone Sus 1% Op","code_information":[{"code":"CP17744631830814076","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tafluprost   Sol 0.0015%","code_information":[{"code":"CP17744631831091222","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993042930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Alosetron    Tab 0.5mg","code_information":[{"code":"CP17744631828435204","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980045303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alosetron    Tab 0.5mg","code_information":[{"code":"CP17744631828435502","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756070230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/atorva Tab 10-80mg","code_information":[{"code":"CP17744631828489013","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505349303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clopidogrel  Tab 300mg","code_information":[{"code":"CP17744631829382691","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367019430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Dexlansopraz Cap 60mg Dr","code_information":[{"code":"CP17744631829571173","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979070406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Metronidazol Inj 500mg","code_information":[{"code":"CP17744631830475979","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Stocking T-h Large 8-15","code_information":[{"code":"CP17744631831071478","type":"CDM"},{"code":"250","type":"RC"},{"code":"5113120134","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tramadol Hcl Tab 50mg","code_information":[{"code":"CP17744631831161888","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084080801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Urinal-male","code_information":[{"code":"CP17744631831218992","type":"CDM"},{"code":"250","type":"RC"},{"code":"80196003864","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glide Wheels Mis 1-1/8\"","code_information":[{"code":"CP17744631830035757","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601045378","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Silver Dress Algicell Ag","code_information":[{"code":"CP17744631831012927","type":"CDM"},{"code":"250","type":"RC"},{"code":"93417","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Verapamil    Cap 300mg Er","code_information":[{"code":"CP17744631831263090","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175048737","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830667788","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383002510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acuicyn      Sol","code_information":[{"code":"CP17744631828323389","type":"CDM"},{"code":"250","type":"RC"},{"code":"68489000027","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compression Gloves Med","code_information":[{"code":"CP17744631829416635","type":"CDM"},{"code":"250","type":"RC"},{"code":"7467669031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compression Socks Kh","code_information":[{"code":"CP17744631829410376","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318960255","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dofetilide   Cap 500mcg","code_information":[{"code":"CP17744631829721120","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291041360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Focalin Xr   Cap 15mg","code_information":[{"code":"CP17744631829995634","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758023701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Focalin Xr   Cap 15mg","code_information":[{"code":"CP17744631829992267","type":"CDM"},{"code":"250","type":"RC"},{"code":"78049","type":"CPT","modifier":"305"}],"standard_charges":[{"setting":"outpatient","modifier_code":["305"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Hammer Toe Crest Small R","code_information":[{"code":"CP17744631830072206","type":"CDM"},{"code":"250","type":"RC"},{"code":"30705","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Polyeth Glyc Pow 3350","code_information":[{"code":"CP17744631830783999","type":"CDM"},{"code":"250","type":"RC"},{"code":"69230032435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pulmicort    Sus 0.5mg/2","code_information":[{"code":"CP17744631830858300","type":"CDM"},{"code":"250","type":"RC"},{"code":"18619","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tirosint     Cap 100mcg","code_information":[{"code":"CP17744631831134980","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858003004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tirosint     Cap 112mcg","code_information":[{"code":"CP17744631831130891","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858003504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":112,"type":"ME"}},{"description":"Tirosint     Cap 125mcg","code_information":[{"code":"CP17744631831135124","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858004004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Tirosint     Cap 137mcg","code_information":[{"code":"CP17744631831134098","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858004504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Tirosint     Cap 13mcg","code_information":[{"code":"CP17744631831139437","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858000504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":13,"type":"ME"}},{"description":"Tirosint     Cap 150mcg","code_information":[{"code":"CP17744631831133538","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858005004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Tirosint     Cap 175mcg","code_information":[{"code":"CP17744631831132451","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858005504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"ME"}},{"description":"Tirosint     Cap 37.5mcg","code_information":[{"code":"CP17744631831133158","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858001204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Tirosint     Cap 44mcg","code_information":[{"code":"CP17744631831139106","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858001304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":44,"type":"ME"}},{"description":"Tirosint     Cap 50mcg","code_information":[{"code":"CP17744631831135783","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858001504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tirosint     Cap 62.5mcg","code_information":[{"code":"CP17744631831131483","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858001704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Tirosint     Cap 75mcg","code_information":[{"code":"CP17744631831139422","type":"CDM"},{"code":"250","type":"RC"},{"code":"71858002004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828831638","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756028951","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Docosanol    Cre 10%","code_information":[{"code":"CP17744631829717874","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000051701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pilocarpine  Sol 2% Op","code_information":[{"code":"CP17744631830775922","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314020415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Saxagliptin  Tab 5mg","code_information":[{"code":"CP17744631830992541","type":"CDM"},{"code":"250","type":"RC"},{"code":"37847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Huber 22g 1in","code_information":[{"code":"CP17744631830082052","type":"CDM"},{"code":"250","type":"RC"},{"code":"58311400000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":22,"type":"GR"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830431502","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682002150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Oxacillin    Inj 1gm","code_information":[{"code":"CP17744631830706860","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679069801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Pantoprazole 2mg/ml Susp","code_information":[{"code":"CP17744631830736456","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756007164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pantoprazole 4mg/ml Susp","code_information":[{"code":"CP17744631830732909","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756007164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Pantoprazole Oral 4mg/ml","code_information":[{"code":"CP17744631830739107","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756007164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Pantoprazole Pak 40mg","code_information":[{"code":"CP17744631830739172","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756007164","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tramadol Hcl Tab 100mg","code_information":[{"code":"CP17744631831155185","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ezy Dose Tab Mis Cutter","code_information":[{"code":"CP17744631829831139","type":"CDM"},{"code":"250","type":"RC"},{"code":"25715067015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pantop40mg/100ml","code_information":[{"code":"CP17744631830735309","type":"CDM"},{"code":"250","type":"RC"},{"code":"80923","type":"CPT","modifier":"55"}],"standard_charges":[{"setting":"outpatient","modifier_code":["55"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pill Cutter","code_information":[{"code":"CP17744631830778929","type":"CDM"},{"code":"250","type":"RC"},{"code":"25715067015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Protonix     Inj 40mg","code_information":[{"code":"CP17744631830852975","type":"CDM"},{"code":"250","type":"RC"},{"code":"80923","type":"CPT","modifier":"51"}],"standard_charges":[{"setting":"outpatient","modifier_code":["51"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Protonix     Inj 40mg","code_information":[{"code":"CP17744631830850135","type":"CDM"},{"code":"250","type":"RC"},{"code":"80923","type":"CPT","modifier":"55"}],"standard_charges":[{"setting":"outpatient","modifier_code":["55"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Protonix 40mg/100ml Ns","code_information":[{"code":"CP17744631830854739","type":"CDM"},{"code":"250","type":"RC"},{"code":"80923","type":"CPT","modifier":"51"}],"standard_charges":[{"setting":"outpatient","modifier_code":["51"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Protonix 40mg/100ml Ns","code_information":[{"code":"CP17744631830852006","type":"CDM"},{"code":"250","type":"RC"},{"code":"80923","type":"CPT","modifier":"55"}],"standard_charges":[{"setting":"outpatient","modifier_code":["55"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sirolimus    Tab 2mg","code_information":[{"code":"CP17744631831029246","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382035201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Talicia      Cap","code_information":[{"code":"CP17744631831090896","type":"CDM"},{"code":"250","type":"RC"},{"code":"57841115002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carvedilol   Cap 10mg Er","code_information":[{"code":"CP17744631829136761","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714022701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cozaar       Tab 100mg","code_information":[{"code":"CP17744631829420025","type":"CDM"},{"code":"250","type":"RC"},{"code":"60960","type":"CPT","modifier":"54"}],"standard_charges":[{"setting":"outpatient","modifier_code":["54"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Durahesive   Waf 45mm 4x4","code_information":[{"code":"CP17744631829754161","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830813548","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin   Cap 300mg","code_information":[{"code":"CP17744631830827950","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pregabalin-100mg-caps","code_information":[{"code":"CP17744631830821356","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin-300mg-caps","code_information":[{"code":"CP17744631830827037","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Priftin      Tab 150mg","code_information":[{"code":"CP17744631830837053","type":"CDM"},{"code":"250","type":"RC"},{"code":"88210","type":"CPT","modifier":"224"}],"standard_charges":[{"setting":"outpatient","modifier_code":["224"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Sod Sul/sulf Lot 10-5%","code_information":[{"code":"CP17744631831047758","type":"CDM"},{"code":"250","type":"RC"},{"code":"44523060701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Briviact     Sol 10mg/ml","code_information":[{"code":"CP17744631828959930","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474087015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Droxidopa    Cap 100mg","code_information":[{"code":"CP17744631829752053","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710138909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Droxidopa    Cap 100mg","code_information":[{"code":"CP17744631829753050","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241019990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Methylphenid Tab 54mg Er","code_information":[{"code":"CP17744631830450633","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037072701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":54,"type":"ME"}},{"description":"Amp/sulb 3gm/100ml Ns Mb","code_information":[{"code":"CP17744631828510761","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Amp/sulbacta Inj 3gm","code_information":[{"code":"CP17744631828517499","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ampicillin/sulb 3 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828523314","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ketamine Lidocaine Amitript Cr","code_information":[{"code":"CP17744631830181373","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779175405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pravastatin  Tab 80mg","code_information":[{"code":"CP17744631830808034","type":"CDM"},{"code":"250","type":"RC"},{"code":"93727","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Unasyn 3 Gm/100 Ml Ns Pb+","code_information":[{"code":"CP17744631831202261","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Asa/dipyrida Cap 25-200mg","code_information":[{"code":"CP17744631828752520","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714096401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Aspirin-dipyridamole 25/200mg","code_information":[{"code":"CP17744631828776837","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714096401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hollister Wafer 14203","code_information":[{"code":"CP17744631830082400","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380014203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Intima Cath 24gx.75","code_information":[{"code":"CP17744631830179542","type":"CDM"},{"code":"250","type":"RC"},{"code":"38331","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Saf-t-intima 24ga 0.75","code_information":[{"code":"CP17744631830175531","type":"CDM"},{"code":"250","type":"RC"},{"code":"38331","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Saf-t-intima Mis 24gx3/4\"","code_information":[{"code":"CP17744631830928184","type":"CDM"},{"code":"250","type":"RC"},{"code":"38331","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Urost Pouch  Mis 2-3/4\"","code_information":[{"code":"CP17744631831210893","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010371","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amp-sulbacta Inj 1.5gm","code_information":[{"code":"CP17744631828535118","type":"CDM"},{"code":"250","type":"RC"},{"code":"66794020641","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Bupropion    Tab 300mg Xl","code_information":[{"code":"CP17744631828985241","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180032009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropion Xl 300mg Tabs","code_information":[{"code":"CP17744631828994350","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180032009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828999173","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180032009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Suboxone     Mis 2-0.5mg","code_information":[{"code":"CP17744631831074825","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496120203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Suboxone Subling Film 2/0.5mg","code_information":[{"code":"CP17744631831075290","type":"CDM"},{"code":"250","type":"RC"},{"code":"12496120203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828797068","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505622601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828799454","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219175008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefepime     Inj 1gm","code_information":[{"code":"CP17744631829161454","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime     Inj 1gm","code_information":[{"code":"CP17744631829168840","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime     Inj 2gm","code_information":[{"code":"CP17744631829168689","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime     Inj 2gm","code_information":[{"code":"CP17744631829163828","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime     Inj 2gm","code_information":[{"code":"CP17744631829167637","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288000920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 1 Gm/50 Ml El-d","code_information":[{"code":"CP17744631829161827","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1gm / 100ml Mb","code_information":[{"code":"CP17744631829162154","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1gm Solr","code_information":[{"code":"CP17744631829161654","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1gm/100ml Ns Mb+","code_information":[{"code":"CP17744631829167962","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1gm/50ml D5w Mb","code_information":[{"code":"CP17744631829167653","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1gm/50ml Ns Mb+","code_information":[{"code":"CP17744631829168300","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 1gm/50ml Ns Mb+","code_information":[{"code":"CP17744631829167419","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime 2 Gm In 50 Ml Ns","code_information":[{"code":"CP17744631829167274","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/ 100 Ml El-j","code_information":[{"code":"CP17744631829163390","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829162824","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829163958","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829165987","type":"CDM"},{"code":"250","type":"RC"},{"code":"40997","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/50 Ml D5w","code_information":[{"code":"CP17744631829168657","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/50 Ml Dw","code_information":[{"code":"CP17744631829169851","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/50 Ml Ns","code_information":[{"code":"CP17744631829166174","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/50 Ml Ns","code_information":[{"code":"CP17744631829166649","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/50 Ml Ns","code_information":[{"code":"CP17744631829168732","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2 Gm/50 Ml Ns Kit","code_information":[{"code":"CP17744631829168052","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Cefepime 2g/ Ns 100ml","code_information":[{"code":"CP17744631829162410","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2g/50ml Ns Mb","code_information":[{"code":"CP17744631829168655","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm / 100ml Mb","code_information":[{"code":"CP17744631829164054","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm / 100ml Mb","code_information":[{"code":"CP17744631829163178","type":"CDM"},{"code":"250","type":"RC"},{"code":"40997","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/100ml","code_information":[{"code":"CP17744631829163913","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/100ml","code_information":[{"code":"CP17744631829164655","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/100ml D5w","code_information":[{"code":"CP17744631829164320","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/100ml Nsmb+","code_information":[{"code":"CP17744631829163743","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/50ml","code_information":[{"code":"CP17744631829162550","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 2gm/50ml","code_information":[{"code":"CP17744631829173594","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime 3 Gm/250 Ml Ns","code_information":[{"code":"CP17744631829177253","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefepime 500gm/50ml","code_information":[{"code":"CP17744631829176850","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"GR"}},{"description":"Cefepime 500mg In 100ml Ns","code_information":[{"code":"CP17744631829172071","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefepime 500mg In 50ml Ns","code_information":[{"code":"CP17744631829177772","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefepime 500mg/100ml Ns","code_information":[{"code":"CP17744631829177184","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefepime 500mg/50ml Ns","code_information":[{"code":"CP17744631829173665","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefepime 500mg/50ml Ns","code_information":[{"code":"CP17744631829175400","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefepime 650mg/50ml Ns","code_information":[{"code":"CP17744631829177312","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Cefepime Hcl Inj 1gm","code_information":[{"code":"CP17744631829176461","type":"CDM"},{"code":"250","type":"RC"},{"code":"40995","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefepime Hcl Inj 2gm","code_information":[{"code":"CP17744631829170338","type":"CDM"},{"code":"250","type":"RC"},{"code":"40997","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefepime Hcl Inj 2gm","code_information":[{"code":"CP17744631829178143","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594009002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829177470","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829174820","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829179859","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829178147","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829175415","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829171171","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829177433","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone  Inj 2gm","code_information":[{"code":"CP17744631829186168","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone  Inj 2gm","code_information":[{"code":"CP17744631829184769","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone  Inj 2gm","code_information":[{"code":"CP17744631829181835","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 1 Gm / 50ml Ns Kit","code_information":[{"code":"CP17744631829180815","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Ceftriaxone 1 Gram/50 Ml El-d","code_information":[{"code":"CP17744631829187579","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1g/100ml Ns","code_information":[{"code":"CP17744631829184383","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1g/100ml Ns","code_information":[{"code":"CP17744631829183865","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1g/100ml Ns","code_information":[{"code":"CP17744631829181831","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1g/100ml Ns","code_information":[{"code":"CP17744631829181639","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm /100ml Mb","code_information":[{"code":"CP17744631829189514","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm /100ml Mb","code_information":[{"code":"CP17744631829181043","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm Inj Solr","code_information":[{"code":"CP17744631829182128","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm Solr","code_information":[{"code":"CP17744631829181895","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/100ml Mb Ns","code_information":[{"code":"CP17744631829188259","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/100ml Mb Ns","code_information":[{"code":"CP17744631829185327","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Mb D5","code_information":[{"code":"CP17744631829181395","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Mb D5w","code_information":[{"code":"CP17744631829185392","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Mb D5w","code_information":[{"code":"CP17744631829184799","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Mb Ns","code_information":[{"code":"CP17744631829183775","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Mb Ns","code_information":[{"code":"CP17744631829180710","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Mb Ns","code_information":[{"code":"CP17744631829185113","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 1gm/50ml Ns","code_information":[{"code":"CP17744631829188685","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftriaxone 2 Gm/100 Ml El-j","code_information":[{"code":"CP17744631829186375","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829185779","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829184437","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829189399","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2g/100ml Mb+","code_information":[{"code":"CP17744631829185366","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2g/100ml Mb+","code_information":[{"code":"CP17744631829188232","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2gm / 100ml","code_information":[{"code":"CP17744631829183048","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2gm/100ml D5w","code_information":[{"code":"CP17744631829185300","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2gm/100ml Ns Mb","code_information":[{"code":"CP17744631829185935","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2gm/100ml Ns Mb","code_information":[{"code":"CP17744631829183133","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2gm/100ml Ns Mb","code_information":[{"code":"CP17744631829185526","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ceftriaxone 2gm/50ml Nsmb Kt","code_information":[{"code":"CP17744631829188641","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cyclophosphamide 25mg Caps","code_information":[{"code":"CP17744631829441778","type":"CDM"},{"code":"250","type":"RC"},{"code":"54038","type":"CPT","modifier":"225"}],"standard_charges":[{"setting":"outpatient","modifier_code":["225"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Haloper Dec  Inj 100mg/ml","code_information":[{"code":"CP17744631830062614","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061681","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hydralazine  Inj 20mg/ml","code_information":[{"code":"CP17744631830098878","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150040025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Iv Pump (2067043)","code_information":[{"code":"CP17744631830175864","type":"CDM"},{"code":"250","type":"RC"},{"code":"20670","type":"CPT","modifier":"43"}],"standard_charges":[{"setting":"outpatient","modifier_code":["43"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ky Vancomycin 2gm/500 Ml Ns","code_information":[{"code":"CP17744631830194920","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ky Vancomycin 2gm/500 Ml Ns","code_information":[{"code":"CP17744631830194798","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Kycefepime 3g/100ml Ns","code_information":[{"code":"CP17744631830196092","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567024010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ma Cefepime 2g/100ml Ns Mb Kit","code_information":[{"code":"CP17744631830398159","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Ma Vancomycin 1 Gm/250 Ml D5w","code_information":[{"code":"CP17744631830392118","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ma Vancomycin 1 Gm/250 Ml Ns","code_information":[{"code":"CP17744631830393247","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ma Vancomycin 2gm/500 Ml Ns","code_information":[{"code":"CP17744631830396910","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Merop/nacl   Inj 1gm/50ml","code_information":[{"code":"CP17744631830426589","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Merop/nacl   Inj 500/50ml","code_information":[{"code":"CP17744631830429670","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Meropenem    Inj 500mg","code_information":[{"code":"CP17744631830429614","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem    Inj 500mg","code_information":[{"code":"CP17744631830424044","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem    Inj 500mg","code_information":[{"code":"CP17744631830424818","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 1gm/ns 50ml","code_information":[{"code":"CP17744631830428600","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 1gm/sodium Chloride","code_information":[{"code":"CP17744631830421067","type":"CDM"},{"code":"250","type":"RC"},{"code":"26431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Meropenem 500mg Solr","code_information":[{"code":"CP17744631830423565","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 500mg/50ml Ns","code_information":[{"code":"CP17744631830422831","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Meropenem 500mg/50ml Ns","code_information":[{"code":"CP17744631830427361","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830492116","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830490876","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830497691","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578000606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Modafinil    Tab 200mg","code_information":[{"code":"CP17744631830493343","type":"CDM"},{"code":"250","type":"RC"},{"code":"55253080230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Modafinil 200mg Tabs","code_information":[{"code":"CP17744631830492110","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332038630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Niacor       Tab 500mg","code_information":[{"code":"CP17744631830556997","type":"CDM"},{"code":"250","type":"RC"},{"code":"71740000110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Pimecrolimus Cre 1%","code_information":[{"code":"CP17744631830774241","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rizatriptan  Tab 10mg","code_information":[{"code":"CP17744631830908576","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877026218","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831170569","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603010801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Vanco 1.25gm/250ml D5w","code_information":[{"code":"CP17744631831227465","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.25gm/250ml D5w","code_information":[{"code":"CP17744631831223762","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.25gm/250ml Ns Vm","code_information":[{"code":"CP17744631831226547","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.25gm/250ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831221212","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.25gm/250ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831227949","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco 1.5gm/250ml Ns","code_information":[{"code":"CP17744631831222366","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vanco 1.5gm/250ml Ns Vm","code_information":[{"code":"CP17744631831222782","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vanco 1.5gm/500ml D5w","code_information":[{"code":"CP17744631831227683","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vanco 1.5gm/500ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831229131","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082499","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vanco 1.5gm/500ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831229899","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vanco 1.8gm/500ml Ns","code_information":[{"code":"CP17744631831227181","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":18,"type":"GR"}},{"description":"Vanco 1gm/250ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831222441","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vanco 1gm/250ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831228235","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vanco 750mg/250 Sod Cl 0.9%","code_information":[{"code":"CP17744631831235383","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vanco 750mg/250 Sod Cl 0.9%","code_information":[{"code":"CP17744631831239817","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vanco Inj 2.3gm/ns 0.9% 500ml","code_information":[{"code":"CP17744631831235827","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":23,"type":"GR"}},{"description":"Vanco1.25g/500ml","code_information":[{"code":"CP17744631831238959","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vanco500mg/100ml-rectal Enema","code_information":[{"code":"CP17744631831238002","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancocin 30mg/ml","code_information":[{"code":"CP17744631831233199","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831233979","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831233289","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831231112","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831235172","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831235330","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714030910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831230995","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831235098","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1.5gm","code_information":[{"code":"CP17744631831239944","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin   Sol 1.5gm","code_information":[{"code":"CP17744631831233821","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082499","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1 Gm In 250 Ml Ns","code_information":[{"code":"CP17744631831230629","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1 Gm/250 Ml D5","code_information":[{"code":"CP17744631831238410","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1 Gm/250 Ml Ns","code_information":[{"code":"CP17744631831237324","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1 Gm/250 Ml Ns","code_information":[{"code":"CP17744631831233374","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1 Gm/250 Ml Ns Vm","code_information":[{"code":"CP17744631831236521","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1 Gm/500ml Ns","code_information":[{"code":"CP17744631831230347","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1.5 G/500ml Ns Kt","code_information":[{"code":"CP17744631831236959","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5 Gm/500 Ml Ns","code_information":[{"code":"CP17744631831233233","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5g Ns 250ml","code_information":[{"code":"CP17744631831232624","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5g/500ml D5w","code_information":[{"code":"CP17744631831233492","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5g/500ml D5w","code_information":[{"code":"CP17744631831238980","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5g/d5w 500ml","code_information":[{"code":"CP17744631831239026","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5gm/500 Ml D5 Vm","code_information":[{"code":"CP17744631831239724","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5gm/500ml Ns","code_information":[{"code":"CP17744631831234420","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5gm/500ml Ns","code_information":[{"code":"CP17744631831231555","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.5gm/500ml Ns","code_information":[{"code":"CP17744631831232055","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Vancomycin 1.75gm In 250ml Ns","code_information":[{"code":"CP17744631831232330","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Vancomycin 1.75gm In 250ml Ns","code_information":[{"code":"CP17744631831232602","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Vancomycin 1.75gm In 500ml Ns","code_information":[{"code":"CP17744631831231939","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714030910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Vancomycin 1.75gm In 500ml Ns","code_information":[{"code":"CP17744631831234306","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Vancomycin 1.75gm/500 Ml D5","code_information":[{"code":"CP17744631831246773","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Vancomycin 1.75gm/500 Ml Ns","code_information":[{"code":"CP17744631831240095","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Vancomycin 1.75gm/500ml Ns","code_information":[{"code":"CP17744631831243123","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":175,"type":"GR"}},{"description":"Vancomycin 1000mg/200ml El-l","code_information":[{"code":"CP17744631831249306","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Vancomycin 1185mg/250ml Ns","code_information":[{"code":"CP17744631831243008","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1185,"type":"ME"}},{"description":"Vancomycin 125 Mg/100 Ml Ns","code_information":[{"code":"CP17744631831242931","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vancomycin 1250mg/250ml Ns","code_information":[{"code":"CP17744631831246955","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Vancomycin 1500 Mg/300 Ml El-l","code_information":[{"code":"CP17744631831242219","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1500,"type":"ME"}},{"description":"Vancomycin 1gm 250ml","code_information":[{"code":"CP17744631831240677","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1gm Solr","code_information":[{"code":"CP17744631831243750","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1gm/250ml","code_information":[{"code":"CP17744631831242154","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 1gm/250ml D5w Vm","code_information":[{"code":"CP17744631831242161","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 2.25gm/500 Ml Ns Kt","code_information":[{"code":"CP17744631831240451","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Vancomycin 2.25gm/500ml Ns","code_information":[{"code":"CP17744631831245366","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Vancomycin 250 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631831248437","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin 250mg/5ml","code_information":[{"code":"CP17744631831240489","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin 2gm In 500ml Ns","code_information":[{"code":"CP17744631831247751","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Vancomycin 2gm/500ml Ns","code_information":[{"code":"CP17744631831242579","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Vancomycin 500mg/tobramycin 80","code_information":[{"code":"CP17744631831249683","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 50mg/ml","code_information":[{"code":"CP17744631831244138","type":"CDM"},{"code":"250","type":"RC"},{"code":"40935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin 50mg/ml","code_information":[{"code":"CP17744631831246251","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin 50mg/ml","code_information":[{"code":"CP17744631831241139","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin 50mg/ml","code_information":[{"code":"CP17744631831244658","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin 600mg/250ml Ns","code_information":[{"code":"CP17744631831243684","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Vancomycin 720 Mg/250 Ml Ns","code_information":[{"code":"CP17744631831248717","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":720,"type":"ME"}},{"description":"Vancomycin 750 Mg/100 Ml Ns Kt","code_information":[{"code":"CP17744631831241173","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750 Mg/250 Ml Ns Kt","code_information":[{"code":"CP17744631831246055","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288002321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750 Mg/250 Ml Ns Kt","code_information":[{"code":"CP17744631831247286","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750mg/250ml Elm","code_information":[{"code":"CP17744631831244444","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 900mg/250ml","code_information":[{"code":"CP17744631831243394","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002182","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828387037","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335070349","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Ankle Knit   Mis Medium","code_information":[{"code":"CP17744631828535914","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295013430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"D3 Liquid 5000u/0.5ml","code_information":[{"code":"CP17744631829450169","type":"CDM"},{"code":"250","type":"RC"},{"code":"40093010532","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Octreotide   Inj 1000/5ml","code_information":[{"code":"CP17744631830650498","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155068531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Rizatriptan  Tab 10mg","code_information":[{"code":"CP17744631830913119","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097086685","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rizatriptan  Tab 10mg Odt","code_information":[{"code":"CP17744631830918516","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862062690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rizatriptan  Tab 10mg Odt","code_information":[{"code":"CP17744631830914938","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237008663","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rizatriptan  Tab 10mg Odt","code_information":[{"code":"CP17744631830910340","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009441","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rizatriptan  Tab 10mg Odt","code_information":[{"code":"CP17744631830918152","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452015773","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rizatriptan  Tab 5mg Odt","code_information":[{"code":"CP17744631830910672","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452015673","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Theophylline Tab 200mg Er","code_information":[{"code":"CP17744631831120619","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033005801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Vitamin D3   Dro 5000 Iu","code_information":[{"code":"CP17744631831296821","type":"CDM"},{"code":"250","type":"RC"},{"code":"40093010532","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5000,"type":"F2"}},{"description":"Vitamin D3 5000unit/0.5ml Drop","code_information":[{"code":"CP17744631831291193","type":"CDM"},{"code":"250","type":"RC"},{"code":"40093010532","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Vitamin D3-5000unit/0.5ml Sol","code_information":[{"code":"CP17744631831296784","type":"CDM"},{"code":"250","type":"RC"},{"code":"40093010532","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Cefuroxime 500mg/50ml Ns","code_information":[{"code":"CP17744631829189724","type":"CDM"},{"code":"250","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cyclosporine Emu 0.05%","code_information":[{"code":"CP17744631829441052","type":"CDM"},{"code":"250","type":"RC"},{"code":"37887","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rizatriptan  Tab 10mg","code_information":[{"code":"CP17744631830905661","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342008841","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rizatriptan  Tab 10mg","code_information":[{"code":"CP17744631830911428","type":"CDM"},{"code":"250","type":"RC"},{"code":"37814","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clonidine    Dis 0.1/24hr","code_information":[{"code":"CP17744631829375265","type":"CDM"},{"code":"250","type":"RC"},{"code":"37808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonidine    Dis 0.1/24hr","code_information":[{"code":"CP17744631829372383","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907002348","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonidine    Dis 0.1/24hr","code_information":[{"code":"CP17744631829373295","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862045304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calc Acetate Cap 667mg","code_information":[{"code":"CP17744631829050192","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155053102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":667,"type":"ME"}},{"description":"Calcium Acetate 667mg Caps","code_information":[{"code":"CP17744631829073508","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155053102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":667,"type":"ME"}},{"description":"Marplan      Tab 10mg","code_information":[{"code":"CP17744631830401724","type":"CDM"},{"code":"250","type":"RC"},{"code":"30698003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prasugrel    Tab 10mg","code_information":[{"code":"CP17744631830803710","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862083030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amox-clav K 1000-62.5mg Tab Er","code_information":[{"code":"CP17744631828500352","type":"CDM"},{"code":"250","type":"RC"},{"code":"78119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Amox-pot Cla Tab Er","code_information":[{"code":"CP17744631828515643","type":"CDM"},{"code":"250","type":"RC"},{"code":"78119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/bac Oin /Hc 1%op","code_information":[{"code":"CP17744631830542768","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208078555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/bac/hc 1%op Oint","code_information":[{"code":"CP17744631830541397","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208078555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829370661","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571034301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Leflunomide  Tab 10mg","code_information":[{"code":"CP17744631830293491","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748012906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sirolimus    Tab 2mg","code_information":[{"code":"CP17744631831029127","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Focalin Xr   Cap 5mg","code_information":[{"code":"CP17744631829993217","type":"CDM"},{"code":"250","type":"RC"},{"code":"78043","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Novolin N    Inj U-100","code_information":[{"code":"CP17744631830572926","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Novolin N 100 Unit/ml Mdv 10ml","code_information":[{"code":"CP17744631830578519","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Cefazolin 2gm/100ml D5w","code_information":[{"code":"CP17744631829150228","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Ns","code_information":[{"code":"CP17744631829157718","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Diclofenac   Sol 2%","code_information":[{"code":"CP17744631829591694","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505040603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Octreotide   Inj 50mcg/ml","code_information":[{"code":"CP17744631830667936","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155068741","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Brimonidine  Sol 0.2% Op","code_information":[{"code":"CP17744631828952647","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dexmethylphe Cap 10mg Er","code_information":[{"code":"CP17744631829571134","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010000501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Doxercalcif  Cap 1mcg","code_information":[{"code":"CP17744631829733564","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Neo/poly/hc  Sol 1% Otic","code_information":[{"code":"CP17744631830547890","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Risperdal    Tab 1mg","code_information":[{"code":"CP17744631830895457","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458030006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Saxagliptin  Tab 5mg","code_information":[{"code":"CP17744631830999399","type":"CDM"},{"code":"250","type":"RC"},{"code":"37847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydromorphon Tab 2mg","code_information":[{"code":"CP17744631830117283","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687057901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ms Contin    Tab 15mg Er","code_information":[{"code":"CP17744631830518206","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858051501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Nitrofurantn Sus 25mg/5ml","code_information":[{"code":"CP17744631830565872","type":"CDM"},{"code":"250","type":"RC"},{"code":"70408023932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831138536","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682081305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Unna Boot Bandage W Zn 4\"","code_information":[{"code":"CP17744631831210007","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784034542","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ampicil/ Sulbact 1.5g/100ml Mb","code_information":[{"code":"CP17744631828529842","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288000520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Megestrol Ac Sus 40mg/ml","code_information":[{"code":"CP17744631830410019","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Zolpidem     Tab 10mg","code_information":[{"code":"CP17744631831404650","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydroxychlor Tab 400mg","code_information":[{"code":"CP17744631830117641","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Ammonium Lac Cre 12%","code_information":[{"code":"CP17744631828498915","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Balmex Compl Cre 11.3%","code_information":[{"code":"CP17744631828833998","type":"CDM"},{"code":"250","type":"RC"},{"code":"30103004100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":113,"type":"EA"}},{"description":"Zileuton Er  Tab 600mg","code_information":[{"code":"CP17744631831395417","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603024601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Novolin      Inj 70/30","code_information":[{"code":"CP17744631830571449","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Novolin 70/30 Mdv 10 Ml","code_information":[{"code":"CP17744631830573420","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Pepto-bismol Sus 525/15ml","code_information":[{"code":"CP17744631830751245","type":"CDM"},{"code":"250","type":"RC"},{"code":"1490003930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Benadryl Itc Gel 2%","code_information":[{"code":"CP17744631828851529","type":"CDM"},{"code":"250","type":"RC"},{"code":"12547017157","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Calcitonin   Spr 200/act","code_information":[{"code":"CP17744631829064183","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884016111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Dexlansopraz Cap 30mg Dr","code_information":[{"code":"CP17744631829574744","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884014711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Dexlansopraz Cap 60mg Dr","code_information":[{"code":"CP17744631829574501","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884014811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dexlansopraz Cap 60mg Dr","code_information":[{"code":"CP17744631829579141","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884014809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ketoprofen   Cap 200mg Er","code_information":[{"code":"CP17744631830198870","type":"CDM"},{"code":"250","type":"RC"},{"code":"37882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Medihoney Dressing 2x2","code_information":[{"code":"CP17744631830405897","type":"CDM"},{"code":"250","type":"RC"},{"code":"80995803130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830718778","type":"CDM"},{"code":"250","type":"RC"},{"code":"40685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Paricalcitol Cap 4 Mcg","code_information":[{"code":"CP17744631830736150","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483068903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Urin Leg Bag Mis Standard","code_information":[{"code":"CP17744631831215296","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380009805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"But/apap/caf/codein Caps","code_information":[{"code":"CP17744631829048537","type":"CDM"},{"code":"250","type":"RC"},{"code":"59126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking K-h Medium 8-15","code_information":[{"code":"CP17744631831065174","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566419329","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xopenex Hfa  Aer","code_information":[{"code":"CP17744631831389781","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402051001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diltiazem Er Tab 360mg","code_information":[{"code":"CP17744631829708602","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829261279","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Divalproex   Tab 250mg Dr","code_information":[{"code":"CP17744631829716387","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084077601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Lisdexamfeta Cap 40mg","code_information":[{"code":"CP17744631830349032","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664004988","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Azel/flutic  Spr 137-50","code_information":[{"code":"CP17744631828801664","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505095303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":137,"type":"EA"}},{"description":"Azelastin-flutic 137-50mcg Spr","code_information":[{"code":"CP17744631828806231","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505095303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Calcitriol   Oin 3mcg/gm","code_information":[{"code":"CP17744631829061215","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802060801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Drain Pouch  Mis 70mm","code_information":[{"code":"CP17744631829743116","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380018014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lisdexamfeta Cap 60mg","code_information":[{"code":"CP17744631830345639","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664005188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Mycophenolat Tab 500mg","code_information":[{"code":"CP17744631830526555","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380072507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Enoxaparin   Inj 40/0.4ml","code_information":[{"code":"CP17744631829782428","type":"CDM"},{"code":"250","type":"RC"},{"code":"81952012424","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Rizatriptan  Tab 5mg","code_information":[{"code":"CP17744631830913146","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342008745","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rizatriptan  Tab 5mg","code_information":[{"code":"CP17744631830916495","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237008763","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rizatriptan  Tab 5mg","code_information":[{"code":"CP17744631830913693","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300031621","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rizatriptan  Tab 5mg","code_information":[{"code":"CP17744631830915385","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342008741","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sirolimus    Sol 1mg/ml","code_information":[{"code":"CP17744631831028363","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505619702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sirolimus    Sol 1mg/ml","code_information":[{"code":"CP17744631831028144","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238159403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Pramipexole 0.375mg Er Tabs","code_information":[{"code":"CP17744631830802124","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111061130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830662180","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238161606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830668425","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603018602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830662181","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756060915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Sod  Inj 5000/0.5","code_information":[{"code":"CP17744631830073244","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288040581","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Heparin Sod Sdv 5000/0.5 Dose","code_information":[{"code":"CP17744631830083211","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288040581","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Metformin Er 1000mg Tabs","code_information":[{"code":"CP17744631830446368","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180033707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Metformin Er Tab 1000mg","code_information":[{"code":"CP17744631830446871","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180033707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Metformin Er Tab 1000mg","code_information":[{"code":"CP17744631830443567","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241018960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Metformin Er Tab 1000mg","code_information":[{"code":"CP17744631830442502","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Metformin Er Tab 1000mg","code_information":[{"code":"CP17744631830447237","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033003206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Metformn Osm Tab 1000 Er","code_information":[{"code":"CP17744631830447833","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Metformn Osm Tab 1000 Er","code_information":[{"code":"CP17744631830448969","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180033707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Metformn Osm Tab 1000 Er","code_information":[{"code":"CP17744631830444430","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033003206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Cozaar       Tab 50mg","code_information":[{"code":"CP17744631829425464","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fenofibrate  Tab 120mg","code_information":[{"code":"CP17744631829853463","type":"CDM"},{"code":"250","type":"RC"},{"code":"82619010201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Isosorb Din  Tab 40mg","code_information":[{"code":"CP17744631830163635","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682019201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Vancomycin   Cap 125mg","code_information":[{"code":"CP17744631831230821","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vancomycin   Cap 125mg","code_information":[{"code":"CP17744631831238534","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180016613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vancomycin   Cap 125mg","code_information":[{"code":"CP17744631831234823","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781072950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vancomycin   Cap 125mg","code_information":[{"code":"CP17744631831237413","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559039020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vancomycin   Cap 125mg","code_information":[{"code":"CP17744631831231730","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781072902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Vancomycin 125mg Caps","code_information":[{"code":"CP17744631831243468","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180016613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Acetic Acid  Sol 0.25%irr","code_information":[{"code":"CP17744631828267881","type":"CDM"},{"code":"250","type":"RC"},{"code":"33806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Acetic Acid 0.25% Irrig Soln","code_information":[{"code":"CP17744631828269006","type":"CDM"},{"code":"250","type":"RC"},{"code":"33806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828790713","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756065225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cimetidine   Tab 200mg","code_information":[{"code":"CP17744631829234130","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cimetidine 200mg Tabs","code_information":[{"code":"CP17744631829233540","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Enbrace Hr   Cap","code_information":[{"code":"CP17744631829777418","type":"CDM"},{"code":"250","type":"RC"},{"code":"64661065030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentami-clindamy-polymixb","code_information":[{"code":"CP17744631830035156","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Polymyxin B 500,000u/d5w 500ml","code_information":[{"code":"CP17744631830784383","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":500000,"type":"UN"}},{"description":"Acitretin    Cap 10mg","code_information":[{"code":"CP17744631828328174","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794008008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Acitretin 10mg Caps","code_information":[{"code":"CP17744631828322965","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794008008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bd Saf-t Int Mis 24gx3/4\"","code_information":[{"code":"CP17744631828846667","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290383313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxycycl Hyc Tab 150mg","code_information":[{"code":"CP17744631829744742","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180065407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Doxycycline  Tab 150mg","code_information":[{"code":"CP17744631829746892","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180065407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Iv Cath Saf-t-intima 24g-3/4in","code_information":[{"code":"CP17744631830176763","type":"CDM"},{"code":"250","type":"RC"},{"code":"33010800000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Catheter Saf-t-intima","code_information":[{"code":"CP17744631830174038","type":"CDM"},{"code":"250","type":"RC"},{"code":"33010800000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Saf-t-intima Mis 24gx3/4\"","code_information":[{"code":"CP17744631830921442","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290383313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Steril Water Inj","code_information":[{"code":"CP17744631831061413","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sterile      Inj Water","code_information":[{"code":"CP17744631831060273","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcium Alginate Dressing","code_information":[{"code":"CP17744631829076537","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247919375","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Cap 100mg Md","code_information":[{"code":"CP17744631829444761","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862046047","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dexlansopraz Cap 60mg Dr","code_information":[{"code":"CP17744631829574143","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979000207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dexmethylphe Cap 20mg Er","code_information":[{"code":"CP17744631829573856","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010000701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Dronabinol   Cap 2.5mg","code_information":[{"code":"CP17744631829748782","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687037521","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluvoxamine  Cap 100mg Er","code_information":[{"code":"CP17744631829982818","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370017511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluvoxamine  Cap 150mg Er","code_information":[{"code":"CP17744631829983238","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452018313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pantoprazole Inj Sod 40mg","code_information":[{"code":"CP17744631830730147","type":"CDM"},{"code":"250","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pregabaln Er Tab 165mg","code_information":[{"code":"CP17744631830827293","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205007830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":165,"type":"ME"}},{"description":"Saf-t-intima 24gauge 0.75","code_information":[{"code":"CP17744631830926144","type":"CDM"},{"code":"250","type":"RC"},{"code":"38332240752","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Epaned       Sol 1mg/ml","code_information":[{"code":"CP17744631829798633","type":"CDM"},{"code":"250","type":"RC"},{"code":"52652400101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estradiol    Tab 10mcg","code_information":[{"code":"CP17744631829823028","type":"CDM"},{"code":"250","type":"RC"},{"code":"93322","type":"CPT","modifier":"308"}],"standard_charges":[{"setting":"outpatient","modifier_code":["308"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fycompa      Sus 0.5mg/ml","code_information":[{"code":"CP17744631830018712","type":"CDM"},{"code":"250","type":"RC"},{"code":"69616029038","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"But/apap/caf Cap Codeine","code_information":[{"code":"CP17744631829037735","type":"CDM"},{"code":"250","type":"RC"},{"code":"54065","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac   Dis 1.3%","code_information":[{"code":"CP17744631829590488","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762070702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sod Chloride Sol 5% Op","code_information":[{"code":"CP17744631831048732","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Triamterene  Cap 100mg","code_information":[{"code":"CP17744631831186054","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993083202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829237200","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436000704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Desoximetas  Oin 0.25%","code_information":[{"code":"CP17744631829567343","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Olanzapine    Tab 15mg Odt","code_information":[{"code":"CP17744631830667476","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 15mg Odt","code_information":[{"code":"CP17744631830663834","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine Odt 15mg Tabs","code_information":[{"code":"CP17744631830675771","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862065803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine Odt 15mg Tabs","code_information":[{"code":"CP17744631830678428","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine Odt 15mg Tabs","code_information":[{"code":"CP17744631830671018","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505327700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Polymem      Pad 4\"x4\"","code_information":[{"code":"CP17744631830781896","type":"CDM"},{"code":"250","type":"RC"},{"code":"35471015044","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroco/apap Tab 7.5-325","code_information":[{"code":"CP17744631830100539","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687040701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Ofloxacin    Dro 0.3%otic","code_information":[{"code":"CP17744631830666860","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505036301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Silver Collagen Dressing","code_information":[{"code":"CP17744631831014376","type":"CDM"},{"code":"250","type":"RC"},{"code":"11723410000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clotrim/beta Cre Diprop","code_information":[{"code":"CP17744631829389320","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clotrimazole/betam/zno Cream","code_information":[{"code":"CP17744631829397587","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lotrisone/zinc Oxide 1:1","code_information":[{"code":"CP17744631830376612","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Risperdal    Tab 0.5mg","code_information":[{"code":"CP17744631830892402","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458030206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Skin Barrier Mis 13/16\"","code_information":[{"code":"CP17744631831021630","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380007805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefdinir     Cap 300mg","code_information":[{"code":"CP17744631829158818","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180071160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829230880","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380088304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829232440","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722010330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829236202","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877050330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829232319","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829233154","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335037983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829234684","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet   Tab 30mg","code_information":[{"code":"CP17744631829232962","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet 30mg Tabs","code_information":[{"code":"CP17744631829231482","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335037983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cinacalcet Oral Sol 5mg/ml","code_information":[{"code":"CP17744631829230117","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diltiazem    Cap 360mg Er","code_information":[{"code":"CP17744631829692480","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742025290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Dutast/tamsu Cap 0.5-0.4","code_information":[{"code":"CP17744631829766189","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382064016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Oxacillin    Inj 1gm","code_information":[{"code":"CP17744631830702994","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Piper/tazo 4.5g/100ml","code_information":[{"code":"CP17744631830776347","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazo 4.5g/100ml El J","code_information":[{"code":"CP17744631830775814","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazo 4.5gm/100ml Kit","code_information":[{"code":"CP17744631830775255","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Piper/tazoba Inj 4-0.5gm","code_information":[{"code":"CP17744631830783733","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Piper/tazobac 4.5g/100ml Ns Mb","code_information":[{"code":"CP17744631830781669","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Piper/tazobac 4.5g/100ml Ns Vm","code_information":[{"code":"CP17744631830784382","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":45,"type":"GR"}},{"description":"Triamterene  Cap 50mg","code_information":[{"code":"CP17744631831187788","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993083102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ampicillin   Inj 2gm","code_information":[{"code":"CP17744631828528658","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Celontin     Cap 300mg","code_information":[{"code":"CP17744631829199393","type":"CDM"},{"code":"250","type":"RC"},{"code":"71052","type":"CPT","modifier":"524"}],"standard_charges":[{"setting":"outpatient","modifier_code":["524"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Olanzapine    Tab 15mg Odt","code_information":[{"code":"CP17744631830664505","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 15mg Odt","code_information":[{"code":"CP17744631830669545","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine Odt 15mg Tabs","code_information":[{"code":"CP17744631830670778","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paliperidone Tab Er 1.5mg","code_information":[{"code":"CP17744631830722759","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162028003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paliperidone Tab Er 1.5mg","code_information":[{"code":"CP17744631830720383","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830723816","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162028103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830727244","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808022301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Paliperidone Tab Er 6mg","code_information":[{"code":"CP17744631830723070","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808022401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"2-pc Barrier Mis 2-3/4\"","code_information":[{"code":"CP17744631828072388","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380003704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bidil        Tab","code_information":[{"code":"CP17744631828878173","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338001009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829235384","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Drainage Bag Kit 2000ml","code_information":[{"code":"CP17744631829740156","type":"CDM"},{"code":"250","type":"RC"},{"code":"8011802001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2000,"type":"ML"}},{"description":"Everolimus   Tab 0.5 Mg","code_information":[{"code":"CP17744631829829689","type":"CDM"},{"code":"250","type":"RC"},{"code":"54047","type":"CPT","modifier":"121"}],"standard_charges":[{"setting":"outpatient","modifier_code":["121"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Haloperidol  Tab 2mg","code_information":[{"code":"CP17744631830079442","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292058401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830429948","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382054906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Paliperidone Tab Er 1.5mg","code_information":[{"code":"CP17744631830727709","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714086601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830725671","type":"CDM"},{"code":"250","type":"RC"},{"code":"37839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830727420","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335076583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830722620","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714086701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Paliperidone Tab Er 6mg","code_information":[{"code":"CP17744631830723438","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714086801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Paliperidone Tab Er 6mg","code_information":[{"code":"CP17744631830726895","type":"CDM"},{"code":"250","type":"RC"},{"code":"37839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Paliperidone Tab Er 6mg","code_information":[{"code":"CP17744631830727321","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335076683","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Albuterol    Aer Hfa","code_information":[{"code":"CP17744631828374674","type":"CDM"},{"code":"250","type":"RC"},{"code":"93317","type":"CPT","modifier":"431"}],"standard_charges":[{"setting":"outpatient","modifier_code":["431"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Hfa 90mcg 200 Inh","code_information":[{"code":"CP17744631828392088","type":"CDM"},{"code":"250","type":"RC"},{"code":"93317","type":"CPT","modifier":"431"}],"standard_charges":[{"setting":"outpatient","modifier_code":["431"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Albuterol Sul Hfa-108mcg/a","code_information":[{"code":"CP17744631828398755","type":"CDM"},{"code":"250","type":"RC"},{"code":"93317","type":"CPT","modifier":"431"}],"standard_charges":[{"setting":"outpatient","modifier_code":["431"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":108,"type":"ME"}},{"description":"Albuterol Sulfate Hfa 90 Mcg","code_information":[{"code":"CP17744631828391068","type":"CDM"},{"code":"250","type":"RC"},{"code":"93317","type":"CPT","modifier":"431"}],"standard_charges":[{"setting":"outpatient","modifier_code":["431"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Baraclude    Sol","code_information":[{"code":"CP17744631828835626","type":"CDM"},{"code":"250","type":"RC"},{"code":"31614","type":"CPT","modifier":"12"}],"standard_charges":[{"setting":"outpatient","modifier_code":["12"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stoma Wafer  Waf 1-1/2\"","code_information":[{"code":"CP17744631831073521","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010376","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Crexont      Cap 35-140mg","code_information":[{"code":"CP17744631829432908","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896096716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Crexont      Cap 52.5-210","code_information":[{"code":"CP17744631829439792","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896096816","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":525,"type":"EA"}},{"description":"Crexont      Cap 70-280mg","code_information":[{"code":"CP17744631829435415","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896096916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Crexont      Cap 87.5-350","code_information":[{"code":"CP17744631829432813","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896097016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Flovent Disk Aer 250mcg","code_information":[{"code":"CP17744631829969059","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Flovent Dsk 250mcg 60 Inh","code_information":[{"code":"CP17744631829964992","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828502323","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714029701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Duoderm Cgf  Mis 4\"x4\"","code_information":[{"code":"CP17744631829755271","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010691","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/hc  Sus 1% Otic","code_information":[{"code":"CP17744631830540328","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980044801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 15mg Odt","code_information":[{"code":"CP17744631830667281","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 15mg Odt","code_information":[{"code":"CP17744631830663989","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 15mg Odt","code_information":[{"code":"CP17744631830664719","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342008507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine Odt 15mg Tabs","code_information":[{"code":"CP17744631830678060","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342008507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine Odt 15mg Tabs","code_information":[{"code":"CP17744631830678782","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Vicks Vapor  Inh","code_information":[{"code":"CP17744631831268058","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000097332","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/atorva Tab 10-10mg","code_information":[{"code":"CP17744631828472346","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505347903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clopidogrel  Tab 300mg","code_information":[{"code":"CP17744631829382778","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111067131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Zinc Oxide   Oin 20%","code_information":[{"code":"CP17744631831406863","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834017002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Thermometer  Mis Digital","code_information":[{"code":"CP17744631831121042","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703000070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rufinamide   Tab 400mg","code_information":[{"code":"CP17744631830922382","type":"CDM"},{"code":"250","type":"RC"},{"code":"54042","type":"CPT","modifier":"623"}],"standard_charges":[{"setting":"outpatient","modifier_code":["623"],"minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Walker Ski Glides 1 Pr","code_information":[{"code":"CP17744631831305740","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601045340","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cardizem La  Tab 240mg","code_information":[{"code":"CP17744631829122033","type":"CDM"},{"code":"250","type":"RC"},{"code":"18720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Cardizem La  Tab 240mg","code_information":[{"code":"CP17744631829124408","type":"CDM"},{"code":"250","type":"RC"},{"code":"18720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Estradiol    Dis 0.0375mg","code_information":[{"code":"CP17744631829816264","type":"CDM"},{"code":"250","type":"RC"},{"code":"37846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Ketorolac    Inj 15mg/ml","code_information":[{"code":"CP17744631830192886","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266023425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lisdexamfeta Cap 20mg","code_information":[{"code":"CP17744631830342529","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781056301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Methylpr Ss  Inj 40mg","code_information":[{"code":"CP17744631830458992","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Methylpred   Tab 4mg","code_information":[{"code":"CP17744631830457793","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762444002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Methylprednisolone Dpak 4mg","code_information":[{"code":"CP17744631830458221","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762444002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Oxacillin    Inj 1gm","code_information":[{"code":"CP17744631830708711","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Paliperidone Er 6mg Tabs","code_information":[{"code":"CP17744631830724334","type":"CDM"},{"code":"250","type":"RC"},{"code":"10147095303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831258476","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877072630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":4,"maximum":5,"gross_charge":5,"discounted_cash":5,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":5},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Desloratadin Tab 5mg Odt","code_information":[{"code":"CP17744631829560773","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111036031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Flutic/salme Aer 500/50","code_information":[{"code":"CP17744631829989953","type":"CDM"},{"code":"250","type":"RC"},{"code":"93751","type":"CPT","modifier":"631"}],"standard_charges":[{"setting":"outpatient","modifier_code":["631"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Flutic/salme Aer 500/50 60inh","code_information":[{"code":"CP17744631829988039","type":"CDM"},{"code":"250","type":"RC"},{"code":"93751","type":"CPT","modifier":"631"}],"standard_charges":[{"setting":"outpatient","modifier_code":["631"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Lidocaine 4% Patch","code_information":[{"code":"CP17744631830331693","type":"CDM"},{"code":"250","type":"RC"},{"code":"45717000851","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Theracare    Pad 4%","code_information":[{"code":"CP17744631831125116","type":"CDM"},{"code":"250","type":"RC"},{"code":"45717000851","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831171710","type":"CDM"},{"code":"250","type":"RC"},{"code":"70302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Cefazolin    Inj 2gm","code_information":[{"code":"CP17744631829147629","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2g/100ml Elj","code_information":[{"code":"CP17744631829155850","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2g/100ml Elastomeric","code_information":[{"code":"CP17744631829151020","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2g/100ml El-j","code_information":[{"code":"CP17744631829155516","type":"CDM"},{"code":"250","type":"RC"},{"code":"14391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Piper/tazoba Inj 4-0.5gm","code_information":[{"code":"CP17744631830783714","type":"CDM"},{"code":"250","type":"RC"},{"code":"78131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Temazepam    Cap 7.5mg","code_information":[{"code":"CP17744631831111581","type":"CDM"},{"code":"250","type":"RC"},{"code":"40699","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Temazepam 7.5mg Caps","code_information":[{"code":"CP17744631831113490","type":"CDM"},{"code":"250","type":"RC"},{"code":"40699","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-40mg","code_information":[{"code":"CP17744631828481804","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlodipine/olmesart 5-40mg Tab","code_information":[{"code":"CP17744631828491481","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lubricat Eye Dro 0.4-0.3%","code_information":[{"code":"CP17744631830382265","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti-itch    Lot 0.5-0.5%","code_information":[{"code":"CP17744631828720985","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dispoz-a-bag Mis Lg 32oz","code_information":[{"code":"CP17744631829718142","type":"CDM"},{"code":"250","type":"RC"},{"code":"8011150332","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tiazac       Cap 360mg/24","code_information":[{"code":"CP17744631831124986","type":"CDM"},{"code":"250","type":"RC"},{"code":"18726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Acid Gone    Sus","code_information":[{"code":"CP17744631828318075","type":"CDM"},{"code":"250","type":"RC"},{"code":"90477","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ampicillin   Cap 500mg","code_information":[{"code":"CP17744631828525364","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ampicillin 500mg Caps","code_information":[{"code":"CP17744631828525564","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Colesevelam  Pak 3.75gm","code_information":[{"code":"CP17744631829405733","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877052330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Lidocaine To Pad 4%","code_information":[{"code":"CP17744631830339178","type":"CDM"},{"code":"250","type":"RC"},{"code":"70512081230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/bac/poly Oin Op","code_information":[{"code":"CP17744631830542717","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571075453","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Advair Disku Aer 500/50","code_information":[{"code":"CP17744631828356297","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Advair Diskus 500/50mcg 60 Inh","code_information":[{"code":"CP17744631828359362","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alosetron    Tab 0.5mg","code_information":[{"code":"CP17744631828433033","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963047903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dailyvite 800","code_information":[{"code":"CP17744631829472540","type":"CDM"},{"code":"250","type":"RC"},{"code":"10542015100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dialyvite 800mg W/ Zinc","code_information":[{"code":"CP17744631829586111","type":"CDM"},{"code":"250","type":"RC"},{"code":"10542015100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829991924","type":"CDM"},{"code":"250","type":"RC"},{"code":"93406","type":"CPT","modifier":"130"}],"standard_charges":[{"setting":"outpatient","modifier_code":["130"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Formoterol 20mcg/2ml Neb Sol","code_information":[{"code":"CP17744631829999789","type":"CDM"},{"code":"250","type":"RC"},{"code":"93406","type":"CPT","modifier":"130"}],"standard_charges":[{"setting":"outpatient","modifier_code":["130"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Naratriptan  Tab 2.5mg","code_information":[{"code":"CP17744631830545336","type":"CDM"},{"code":"250","type":"RC"},{"code":"54027","type":"CPT","modifier":"903"}],"standard_charges":[{"setting":"outpatient","modifier_code":["903"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nicoderm Cq  Dis 14mg/24h","code_information":[{"code":"CP17744631830551942","type":"CDM"},{"code":"250","type":"RC"},{"code":"13501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Dilaudid     Tab 4mg","code_information":[{"code":"CP17744631829602178","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858023401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Futuro Large Mis Knee Brc","code_information":[{"code":"CP17744631830014886","type":"CDM"},{"code":"250","type":"RC"},{"code":"8225004405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Dressing Change Tray","code_information":[{"code":"CP17744631830177463","type":"CDM"},{"code":"250","type":"RC"},{"code":"81535","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Piper/tazoba Inj 4-0.5gm","code_information":[{"code":"CP17744631830786186","type":"CDM"},{"code":"250","type":"RC"},{"code":"61990013002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Iv Dressing Chang Kit","code_information":[{"code":"CP17744631830172293","type":"CDM"},{"code":"250","type":"RC"},{"code":"47108","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Humulin      Inj 70/30","code_information":[{"code":"CP17744631830095377","type":"CDM"},{"code":"250","type":"RC"},{"code":"28715","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Humulin 70/30 Mdv 10ml","code_information":[{"code":"CP17744631830098076","type":"CDM"},{"code":"250","type":"RC"},{"code":"28715","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Humulin N    Inj U-100","code_information":[{"code":"CP17744631830096829","type":"CDM"},{"code":"250","type":"RC"},{"code":"28315","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humulin N 100 Unit/ml Mdv10ml","code_information":[{"code":"CP17744631830098509","type":"CDM"},{"code":"250","type":"RC"},{"code":"28315","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Katerzia     Sus 1mg/ml","code_information":[{"code":"CP17744631830184475","type":"CDM"},{"code":"250","type":"RC"},{"code":"52652500101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nicardipine  Cap 30mg","code_information":[{"code":"CP17744631830553249","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462012190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Male Urinal  Mis","code_information":[{"code":"CP17744631830399303","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601087070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Polymem      Pad 4\"x4\"","code_information":[{"code":"CP17744631830786363","type":"CDM"},{"code":"250","type":"RC"},{"code":"35471025044","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amp/sulbacta Inj 3gm","code_information":[{"code":"CP17744631828516990","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ampicillin/sulb 9gm/250 Ml Ns","code_information":[{"code":"CP17744631828523451","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":9,"type":"GR"}},{"description":"Ampi-sulb 3gm/100ml Mb+","code_information":[{"code":"CP17744631828532384","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Amp-sulbacta Inj 3gm","code_information":[{"code":"CP17744631828530005","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Pulmicort    Sus 0.25mg/2","code_information":[{"code":"CP17744631830850603","type":"CDM"},{"code":"250","type":"RC"},{"code":"18619","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Simply Salin Aer 0.9%","code_information":[{"code":"CP17744631831021821","type":"CDM"},{"code":"250","type":"RC"},{"code":"50486002930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Tobra/dexame Sus 0.3-0.1%","code_information":[{"code":"CP17744631831141360","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Amlod/atorva Tab 10-80mg","code_information":[{"code":"CP17744631828486721","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993027330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dextrose     Inj 10%","code_information":[{"code":"CP17744631829582951","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Dextrose Inj 10% 1000ml","code_information":[{"code":"CP17744631829586401","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Viokace      Tab 10440","code_information":[{"code":"CP17744631831277365","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562010410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10440,"type":"EA"}},{"description":"Viokace 10440 Tabs","code_information":[{"code":"CP17744631831274956","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562010410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10440,"type":"EA"}},{"description":"Carvedilol   Cap 80mg Er","code_information":[{"code":"CP17744631829132775","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714023001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Prednisone   Con 5mg/ml","code_information":[{"code":"CP17744631830818421","type":"CDM"},{"code":"250","type":"RC"},{"code":"54372","type":"CPT","modifier":"144"}],"standard_charges":[{"setting":"outpatient","modifier_code":["144"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chapstick    Mis Medicate","code_information":[{"code":"CP17744631829201186","type":"CDM"},{"code":"250","type":"RC"},{"code":"57307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Povidone-iod Sol 10%","code_information":[{"code":"CP17744631830806565","type":"CDM"},{"code":"250","type":"RC"},{"code":"39523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Amp-sulbacta Inj 2-1gm","code_information":[{"code":"CP17744631828539639","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Mesalamine   Tab 1.2gm","code_information":[{"code":"CP17744631830435323","type":"CDM"},{"code":"250","type":"RC"},{"code":"59122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831141874","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668019090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Alogliptin   Tab 25mg","code_information":[{"code":"CP17744631828433407","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802015065","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Alogliptin * Not Avail","code_information":[{"code":"CP17744631828434705","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802015065","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alogliptin 25mg Tab","code_information":[{"code":"CP17744631828439014","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802015065","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Oxycodone    Tab 20mg Er","code_information":[{"code":"CP17744631830715495","type":"CDM"},{"code":"250","type":"RC"},{"code":"93573","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Stocking K-h Large 8-15","code_information":[{"code":"CP17744631831063126","type":"CDM"},{"code":"250","type":"RC"},{"code":"3566419330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroco/apap Tab 10-325mg","code_information":[{"code":"CP17744631830109676","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rufinamide   Tab 400mg","code_information":[{"code":"CP17744631830923899","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071408","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Rufinamide   Tab 400mg","code_information":[{"code":"CP17744631830926950","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651061708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Androgel     Gel 1%(50mg)","code_information":[{"code":"CP17744631828532335","type":"CDM"},{"code":"250","type":"RC"},{"code":"51845","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Excedrin Tns Tab Headache","code_information":[{"code":"CP17744631829835297","type":"CDM"},{"code":"250","type":"RC"},{"code":"67813","type":"CPT","modifier":"901"}],"standard_charges":[{"setting":"outpatient","modifier_code":["901"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kaletra 100/25mg Tabs","code_information":[{"code":"CP17744631830184340","type":"CDM"},{"code":"250","type":"RC"},{"code":"74052","type":"CPT","modifier":"260"}],"standard_charges":[{"setting":"outpatient","modifier_code":["260"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830875168","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304001760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Selegiline   Tab 5mg","code_information":[{"code":"CP17744631830995582","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505343803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tazicef      Inj 1gm","code_information":[{"code":"CP17744631831107542","type":"CDM"},{"code":"250","type":"RC"},{"code":"40950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tazicef      Inj 1gm","code_information":[{"code":"CP17744631831103252","type":"CDM"},{"code":"250","type":"RC"},{"code":"40950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828389092","type":"CDM"},{"code":"250","type":"RC"},{"code":"48795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Albuterol Sul 0.083% Nebu","code_information":[{"code":"CP17744631828391276","type":"CDM"},{"code":"250","type":"RC"},{"code":"48795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Apriso       Cap 0.375gm","code_information":[{"code":"CP17744631828733369","type":"CDM"},{"code":"250","type":"RC"},{"code":"65649010302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Bedpan       Mis Standard","code_information":[{"code":"CP17744631828856979","type":"CDM"},{"code":"250","type":"RC"},{"code":"38703000082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cipro/dexa   Sus 0.3-0.1%","code_information":[{"code":"CP17744631829230691","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485062513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Irbesar/hctz Tab 300-12.5","code_information":[{"code":"CP17744631830162943","type":"CDM"},{"code":"250","type":"RC"},{"code":"93823","type":"CPT","modifier":"256"}],"standard_charges":[{"setting":"outpatient","modifier_code":["256"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Iv Secondary Set","code_information":[{"code":"CP17744631830175844","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Secondery Set 35\"","code_information":[{"code":"CP17744631830176474","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Depakote     Tab 250mg Dr","code_information":[{"code":"CP17744631829554377","type":"CDM"},{"code":"250","type":"RC"},{"code":"74732","type":"CPT","modifier":"613"}],"standard_charges":[{"setting":"outpatient","modifier_code":["613"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Hot/cold Pak Pad","code_information":[{"code":"CP17744631830082252","type":"CDM"},{"code":"250","type":"RC"},{"code":"49022020274","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Protriptylin Tab 10mg","code_information":[{"code":"CP17744631830858077","type":"CDM"},{"code":"250","type":"RC"},{"code":"54021","type":"CPT","modifier":"125"}],"standard_charges":[{"setting":"outpatient","modifier_code":["125"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tobramycin   Neb 300/5ml","code_information":[{"code":"CP17744631831144017","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162091446","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tobramycin   Neb 300/5ml","code_information":[{"code":"CP17744631831145217","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877067870","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Aliskiren    Tab 300mg","code_information":[{"code":"CP17744631828402610","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884042511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Diclofenac   Dis 1.3%","code_information":[{"code":"CP17744631829592477","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347040505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocelluar Fm Dressing","code_information":[{"code":"CP17744631830098223","type":"CDM"},{"code":"250","type":"RC"},{"code":"47370000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thiamine Hcl Inj 200/2ml","code_information":[{"code":"CP17744631831122512","type":"CDM"},{"code":"250","type":"RC"},{"code":"64162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Cephalexin   Cap 750mg","code_information":[{"code":"CP17744631829192567","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Lamotrigine  Tab 50mg Er","code_information":[{"code":"CP17744631830210405","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722024130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lanthanum    Chw 1000mg","code_information":[{"code":"CP17744631830217277","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097093698","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Aquaphor     Mis Lip Repr","code_information":[{"code":"CP17744631828731045","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140002515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dilaudid     Tab 4mg","code_information":[{"code":"CP17744631829609376","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858023450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Griseofulvin Tab Ultr 250","code_information":[{"code":"CP17744631830054399","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980018501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Muro 128     Oin 5% Op","code_information":[{"code":"CP17744631830520706","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208038556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":128,"type":"EA"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830654553","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382037001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 5mg Odt","code_information":[{"code":"CP17744631830664824","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine   Tab 5mg Odt","code_information":[{"code":"CP17744631830663988","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine Odt 5mg Tabs","code_information":[{"code":"CP17744631830679154","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fibracol     Pad 2\"x2\"","code_information":[{"code":"CP17744631829954824","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137002481","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fibracol Plus Cllgm/alg","code_information":[{"code":"CP17744631829952139","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Cath Saf-t-intima 22g-3/4in","code_information":[{"code":"CP17744631830175993","type":"CDM"},{"code":"250","type":"RC"},{"code":"33011000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Catheter Saf-t-intima","code_information":[{"code":"CP17744631830177708","type":"CDM"},{"code":"250","type":"RC"},{"code":"33011000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Intima Safety Cath","code_information":[{"code":"CP17744631830173220","type":"CDM"},{"code":"250","type":"RC"},{"code":"38332","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sm Antacid   Sus Advanced","code_information":[{"code":"CP17744631831031858","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348030239","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Citra Er Tab 1080mg","code_information":[{"code":"CP17744631830799008","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382053701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1080,"type":"ME"}},{"description":"Pot Citrate  Tab 1080mg","code_information":[{"code":"CP17744631830790397","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382053701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1080,"type":"ME"}},{"description":"Pramosone    Lot 1%","code_information":[{"code":"CP17744631830806376","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766072906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Skin Staple Removal Kitpr","code_information":[{"code":"CP17744631831023207","type":"CDM"},{"code":"250","type":"RC"},{"code":"7387002739","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Skin Staple Remover Kit","code_information":[{"code":"CP17744631831028229","type":"CDM"},{"code":"250","type":"RC"},{"code":"7387002738","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atazanavir   Cap 200mg","code_information":[{"code":"CP17744631828775394","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862071260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Bupropion    Tab 450mg Xl","code_information":[{"code":"CP17744631828985579","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781063730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Bupropion    Tab 450mg Xl","code_information":[{"code":"CP17744631828995254","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679083001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Bupropion Er 450mg Tabs","code_information":[{"code":"CP17744631828992424","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679083001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Bupropn Hcl  Tab 450mg Xl","code_information":[{"code":"CP17744631829003960","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781063730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Bupropn Hcl  Tab 450mg Xl","code_information":[{"code":"CP17744631829000914","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679083001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Carvedilol   Cap 40mg Er","code_information":[{"code":"CP17744631829130667","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505471503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Hc Pramoxine Cre 2.5-1%","code_information":[{"code":"CP17744631830072645","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802012464","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Humulin R    Inj U-100","code_information":[{"code":"CP17744631830096173","type":"CDM"},{"code":"250","type":"RC"},{"code":"20213","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Humulin R 100 Units/ml Mdv 3ml","code_information":[{"code":"CP17744631830093143","type":"CDM"},{"code":"250","type":"RC"},{"code":"20213","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"UN"}},{"description":"Ivabradine   Tab 5mg","code_information":[{"code":"CP17744631830177529","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742036260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Levalbutero Neb 1.25/0.5 30ml","code_information":[{"code":"CP17744631830291194","type":"CDM"},{"code":"250","type":"RC"},{"code":"37869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Levalbutero Neb 1.25/0.5 30via","code_information":[{"code":"CP17744631830291867","type":"CDM"},{"code":"250","type":"RC"},{"code":"37869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Levalbuterol Neb 1.25/0.5","code_information":[{"code":"CP17744631830290089","type":"CDM"},{"code":"250","type":"RC"},{"code":"37869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Morphine Sul Cap 10mg Er","code_information":[{"code":"CP17744631830508653","type":"CDM"},{"code":"250","type":"RC"},{"code":"22835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olopatadine  Sol 0.2%","code_information":[{"code":"CP17744631830671729","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830729848","type":"CDM"},{"code":"250","type":"RC"},{"code":"10147095203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Felbamate    Tab 400mg","code_information":[{"code":"CP17744631829845357","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781062701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Pimecrolimus Cre 1%","code_information":[{"code":"CP17744631830774934","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Budesonide   Sus 0.25mg/2","code_information":[{"code":"CP17744631828952091","type":"CDM"},{"code":"250","type":"RC"},{"code":"93681","type":"CPT","modifier":"555"}],"standard_charges":[{"setting":"outpatient","modifier_code":["555"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829219611","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710113301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Triamcin Ace Inj 400/10ml","code_information":[{"code":"CP17744631831175165","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603040101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Amlod/atorva Tab 10-40mg","code_information":[{"code":"CP17744631828485223","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993027230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Baclofen     Sus 25mg/5ml","code_information":[{"code":"CP17744631828828244","type":"CDM"},{"code":"250","type":"RC"},{"code":"71225014001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Verapamil    Cap 100mg Er","code_information":[{"code":"CP17744631831264510","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175048537","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Arch Super Sport","code_information":[{"code":"CP17744631828737135","type":"CDM"},{"code":"250","type":"RC"},{"code":"80376002011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupropion    Tab 450mg Xl","code_information":[{"code":"CP17744631828991449","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979024806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Bupropn Hcl  Tab 450mg Xl","code_information":[{"code":"CP17744631829003920","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979024806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Enalaprilat  Inj 1.25/ml","code_information":[{"code":"CP17744631829770647","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Iv Ext.  Set W/ultrasite","code_information":[{"code":"CP17744631830176463","type":"CDM"},{"code":"250","type":"RC"},{"code":"47343","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystop       Pow 100000","code_information":[{"code":"CP17744631830654864","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Menthol-zinc Oin","code_information":[{"code":"CP17744631830420858","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135070104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ostomy Belt  Mis Medium","code_information":[{"code":"CP17744631830693208","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380007300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dofetilide   Cap 500mcg","code_information":[{"code":"CP17744631829725220","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862000560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"First Aid Kit","code_information":[{"code":"CP17744631829950530","type":"CDM"},{"code":"250","type":"RC"},{"code":"81370008274","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Risperidone   Tab 2mg Odt","code_information":[{"code":"CP17744631830898906","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884040191","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Risperidone  Tab 2mg Odt","code_information":[{"code":"CP17744631830905083","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884040191","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Carvedilol   Cap 40mg Er","code_information":[{"code":"CP17744631829132997","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664066583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Carvedilol Er 40mg Cap","code_information":[{"code":"CP17744631829147163","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664066583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Icosapent    Cap 1gm","code_information":[{"code":"CP17744631830130821","type":"CDM"},{"code":"250","type":"RC"},{"code":"54050","type":"CPT","modifier":"823"}],"standard_charges":[{"setting":"outpatient","modifier_code":["823"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tizanidine   Tab 4mg","code_information":[{"code":"CP17744631831132233","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268076015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Xcopri       Pak 12.5-25","code_information":[{"code":"CP17744631831383412","type":"CDM"},{"code":"250","type":"RC"},{"code":"71699020128","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ban/b Aloe Vera Gel","code_information":[{"code":"CP17744631828838039","type":"CDM"},{"code":"250","type":"RC"},{"code":"7965600007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829210250","type":"CDM"},{"code":"250","type":"RC"},{"code":"78159","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Moxifloxacin 400mg Tabs","code_information":[{"code":"CP17744631830512572","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Moxifloxacin Tab 400mg","code_information":[{"code":"CP17744631830517594","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991094333","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Moxifloxacin Tab 400mg","code_information":[{"code":"CP17744631830517240","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Moxifloxacin Tab 400mg","code_information":[{"code":"CP17744631830510926","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111011230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Amantadine   Cap 100mg","code_information":[{"code":"CP17744631828459822","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332024671","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amantadine 100mg Caps","code_information":[{"code":"CP17744631828463932","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332024671","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Diltiazem    Tab 360mg Er","code_information":[{"code":"CP17744631829694678","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097099602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Pimecrolimus Cre 1%","code_information":[{"code":"CP17744631830777652","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462060935","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"2-pc Barrier Mis 2-3/4\"","code_information":[{"code":"CP17744631828071372","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380003724","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ace 4 In Elastic Bandage","code_information":[{"code":"CP17744631828185965","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290207445","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ace Elastic  Mis Bndg 4\"","code_information":[{"code":"CP17744631828186985","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020814","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atazanavir 200mg Caps","code_information":[{"code":"CP17744631828776722","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714086101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Citalopram   Tab 10mg","code_information":[{"code":"CP17744631829245454","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668000901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mask Cloth Reusable","code_information":[{"code":"CP17744631830409553","type":"CDM"},{"code":"250","type":"RC"},{"code":"86878946017","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sharps Container 5 Quarts","code_information":[{"code":"CP17744631831017210","type":"CDM"},{"code":"250","type":"RC"},{"code":"88139","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sumatriptan  Tab 25mg","code_information":[{"code":"CP17744631831081705","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756052069","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sumatriptan  Tab 25mg","code_information":[{"code":"CP17744631831085468","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862014636","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sumatriptan  Tab 25mg","code_information":[{"code":"CP17744631831085475","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111029198","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Sumatriptan  Tab 25mg","code_information":[{"code":"CP17744631831088181","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714079601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methylphenid Cap 30mg Er","code_information":[{"code":"CP17744631830448210","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010001401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Octreotide   Inj 50mcg/ml","code_information":[{"code":"CP17744631830660870","type":"CDM"},{"code":"250","type":"RC"},{"code":"70333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Quetiapine   Tab 400mg Er","code_information":[{"code":"CP17744631830862329","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729009712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quetiapine   Tab 400mg Er","code_information":[{"code":"CP17744631830868348","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180061607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quetiapine   Tab 400mg Er","code_information":[{"code":"CP17744631830863025","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228038460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quetiapine   Tab 400mg Er","code_information":[{"code":"CP17744631830868482","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quetiapine Xr 400 Mg Tablets","code_information":[{"code":"CP17744631830869669","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729009712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quinidine Gl Tab 324mg Cr","code_information":[{"code":"CP17744631830875828","type":"CDM"},{"code":"250","type":"RC"},{"code":"53489014101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":324,"type":"ME"}},{"description":"Topiramate   Cap Er 25mg","code_information":[{"code":"CP17744631831153777","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"True Metrix  Sol Level 1","code_information":[{"code":"CP17744631831195533","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151145001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"True Metrix  Sol Level 2","code_information":[{"code":"CP17744631831193948","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151145002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"True Metrix  Sol Level 3","code_information":[{"code":"CP17744631831191945","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151145003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Ceftriaxone  Inj 500mg","code_information":[{"code":"CP17744631829185192","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Divalproex   Cap 125mg","code_information":[{"code":"CP17744631829719015","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241011505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Divalproex   Cap 125mg Dr","code_information":[{"code":"CP17744631829719945","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241011505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Tiazac       Cap 360mg/24","code_information":[{"code":"CP17744631831129207","type":"CDM"},{"code":"250","type":"RC"},{"code":"18726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Tobramycin   Neb 300/5ml","code_information":[{"code":"CP17744631831145377","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714011903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Cardizem La  Tab 180mg","code_information":[{"code":"CP17744631829128360","type":"CDM"},{"code":"250","type":"RC"},{"code":"18720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830920202","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462026190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829211526","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205010791","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tylenol      Cap 325mg","code_information":[{"code":"CP17744631831207141","type":"CDM"},{"code":"250","type":"RC"},{"code":"45048","type":"CPT","modifier":"720"}],"standard_charges":[{"setting":"outpatient","modifier_code":["720"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Ampicillin   Inj 2gm","code_information":[{"code":"CP17744631828529212","type":"CDM"},{"code":"250","type":"RC"},{"code":"67850002210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Atropine Sul Oin 1% Op","code_information":[{"code":"CP17744631828794925","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208082555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol    Dis 0.075mg","code_information":[{"code":"CP17744631829821291","type":"CDM"},{"code":"250","type":"RC"},{"code":"37846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Estradiol 0.075mg/24hr Patch","code_information":[{"code":"CP17744631829821218","type":"CDM"},{"code":"250","type":"RC"},{"code":"37846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829987196","type":"CDM"},{"code":"250","type":"RC"},{"code":"52717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Iv Intima Cath 22gx.75","code_information":[{"code":"CP17744631830177064","type":"CDM"},{"code":"250","type":"RC"},{"code":"38332300000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/bac/poly Oin Op","code_information":[{"code":"CP17744631830548010","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208078055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/hc  Sus 1% Otic","code_information":[{"code":"CP17744631830548577","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pregabaln Er Tab 330mg","code_information":[{"code":"CP17744631830824156","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205007930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Saf-t-intima 22gx.75\" Catheter","code_information":[{"code":"CP17744631830924329","type":"CDM"},{"code":"250","type":"RC"},{"code":"38332300000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Saf-t-intima Mis 22gx3/4\"","code_information":[{"code":"CP17744631830925673","type":"CDM"},{"code":"250","type":"RC"},{"code":"38332300000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Oin 5%","code_information":[{"code":"CP17744631828334552","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668051502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Acyclovir    Oin 5%","code_information":[{"code":"CP17744631828330973","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700010716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829819951","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Optifoam Adh Dress 4x4","code_information":[{"code":"CP17744631830699225","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327051527","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen. G 3mu In 100ml Ns","code_information":[{"code":"CP17744631830741903","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Pen. G 3mu In 50ml Ns","code_information":[{"code":"CP17744631830745011","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Pen. G 3mu/100ml Ns","code_information":[{"code":"CP17744631830743684","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Penicilin Gk 24mu/1000 Ns Kt","code_information":[{"code":"CP17744631830743766","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":24,"type":"EA"}},{"description":"Penicilin Gk Inj 24mu/1000 D5w","code_information":[{"code":"CP17744631830741812","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":24,"type":"EA"}},{"description":"Penicillin 4 Mu/50ml Eld","code_information":[{"code":"CP17744631830742413","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicillin Gk 3mu In 50ml D5w","code_information":[{"code":"CP17744631830748209","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicilln Gk 3mu In 50 Ml D5","code_information":[{"code":"CP17744631830742030","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicilln Gk 3mu/50 Ml D5","code_information":[{"code":"CP17744631830746327","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicilln Gk 3mu/50 Ml Ns","code_information":[{"code":"CP17744631830743224","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicilln Gk 4 Mu/100 Ml Ns","code_information":[{"code":"CP17744631830747948","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Penicilln Gk 4 Mu/50 Ml D5","code_information":[{"code":"CP17744631830744818","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicilln Gk 4 Mu/50 Ml Ns","code_information":[{"code":"CP17744631830744670","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicilln Gk 4 Mu/50ml Ns","code_information":[{"code":"CP17744631830747523","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Penicilln Gk 5mu/100 Ml Mb","code_information":[{"code":"CP17744631830745841","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Penicilln Gk Inj 5mu","code_information":[{"code":"CP17744631830748825","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567031110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Rivastigmine Dis 13.3/24","code_information":[{"code":"CP17744631830908734","type":"CDM"},{"code":"250","type":"RC"},{"code":"78173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Theo-24      Cap 100mg Cr","code_information":[{"code":"CP17744631831129261","type":"CDM"},{"code":"250","type":"RC"},{"code":"52244010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Erythromycin Tab 500mg Bs","code_information":[{"code":"CP17744631829811719","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834024330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Isoniazid    Tab 300mg","code_information":[{"code":"CP17744631830160495","type":"CDM"},{"code":"250","type":"RC"},{"code":"64950021703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Isosorb Mono Tab 20mg","code_information":[{"code":"CP17744631830165431","type":"CDM"},{"code":"250","type":"RC"},{"code":"81665010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pramipexole  Tab 0.125mg","code_information":[{"code":"CP17744631830808343","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668009190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Pramipexole Dihyd 0.125mg Tabs","code_information":[{"code":"CP17744631830808081","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668009190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Diazepam     Inj 5mg/ml","code_information":[{"code":"CP17744631829583095","type":"CDM"},{"code":"250","type":"RC"},{"code":"40932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diazepam-5mg/mlinj.","code_information":[{"code":"CP17744631829581988","type":"CDM"},{"code":"250","type":"RC"},{"code":"40932","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Testost Cyp  Inj 100mg/ml","code_information":[{"code":"CP17744631831115110","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Clozapine    Tab 100/odt","code_information":[{"code":"CP17744631829399851","type":"CDM"},{"code":"250","type":"RC"},{"code":"93541","type":"CPT","modifier":"984"}],"standard_charges":[{"setting":"outpatient","modifier_code":["984"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Modafinil    Tab 100mg","code_information":[{"code":"CP17744631830494265","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505252603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Clear Eyes   Dro Red/relf","code_information":[{"code":"CP17744631829240393","type":"CDM"},{"code":"250","type":"RC"},{"code":"78112025415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829814213","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714097902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Xarelto      Sus 1mg/ml","code_information":[{"code":"CP17744631831381441","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458057501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Conti Castil Bar Soap","code_information":[{"code":"CP17744631829419128","type":"CDM"},{"code":"250","type":"RC"},{"code":"38485032153","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clotrimazole Cre 1%","code_information":[{"code":"CP17744631829387637","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462018117","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 250mg Er","code_information":[{"code":"CP17744631830217518","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Silver Sulfa/clotrimazole Cre","code_information":[{"code":"CP17744631831024208","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462018117","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Urinal Female","code_information":[{"code":"CP17744631831210698","type":"CDM"},{"code":"250","type":"RC"},{"code":"81506701167","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829729432","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ethacrynic Acid 25mg Tabs","code_information":[{"code":"CP17744631829824970","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799040501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830483810","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291056290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diltiazem    Cap 120mg Er","code_information":[{"code":"CP17744631829687828","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Metoclopram  Sol 5mg/5ml","code_information":[{"code":"CP17744631830452097","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559019016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metoclopramide  5mg/5ml Sol","code_information":[{"code":"CP17744631830451801","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559019016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Niacor       Tab 500mg","code_information":[{"code":"CP17744631830559497","type":"CDM"},{"code":"250","type":"RC"},{"code":"71740020110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Octreotide   Inj 100mcg","code_information":[{"code":"CP17744631830653725","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323037601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Argiment At  Pak","code_information":[{"code":"CP17744631828746170","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688001220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cetaphil/triamc 0.1%/mupirocin","code_information":[{"code":"CP17744631829202258","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine Er 300mg Tabs","code_information":[{"code":"CP17744631830212547","type":"CDM"},{"code":"250","type":"RC"},{"code":"22815","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Promethazine 12.5mg Supp","code_information":[{"code":"CP17744631830848944","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672529601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Stocking Sm Long","code_information":[{"code":"CP17744631831078031","type":"CDM"},{"code":"250","type":"RC"},{"code":"76318958791","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triam 0.1/bactro Oi/cetaphil","code_information":[{"code":"CP17744631831174381","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triam 0.1/mupiro Cr/cetaphil","code_information":[{"code":"CP17744631831173462","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinol/clotrimaz/zinc/myla","code_information":[{"code":"CP17744631831171190","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinolon Cre 0.1%","code_information":[{"code":"CP17744631831187438","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zin20/nys/tri0.1/lid3 2:1:1:1","code_information":[{"code":"CP17744631831390536","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877025130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zolmitriptan Tab 5mg","code_information":[{"code":"CP17744631831409534","type":"CDM"},{"code":"250","type":"RC"},{"code":"71626010203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bd Saf-t-int Mis 22gx3/4\"","code_information":[{"code":"CP17744631828849863","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290383323","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Micropore    Tap 2\"x10yds","code_information":[{"code":"CP17744631830489144","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333153002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Saf-t-intima Mis 22gx3/4\"","code_information":[{"code":"CP17744631830928666","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290383323","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Seroquel     Tab 25mg","code_information":[{"code":"CP17744631831008872","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Seroquel Tab 25mg","code_information":[{"code":"CP17744631831009412","type":"CDM"},{"code":"250","type":"RC"},{"code":"31002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amphet/dextr Tab 5mg","code_information":[{"code":"CP17744631828526805","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806033901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Delzicol     Cap 400mg","code_information":[{"code":"CP17744631829552632","type":"CDM"},{"code":"250","type":"RC"},{"code":"23585","type":"CPT","modifier":"318"}],"standard_charges":[{"setting":"outpatient","modifier_code":["318"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Kapspargo    Cap 50mg","code_information":[{"code":"CP17744631830182891","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631000930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ketorolac    Tab 10mg","code_information":[{"code":"CP17744631830194944","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452027520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Triamcinolon Pst Den 0.1%","code_information":[{"code":"CP17744631831181609","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinolone 0.1% Paste","code_information":[{"code":"CP17744631831184276","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Theophylline Tab 300mg Er","code_information":[{"code":"CP17744631831122564","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155074101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Tobramycin   Neb 300/5ml","code_information":[{"code":"CP17744631831145511","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335017149","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tobramycin   Neb 300/5ml","code_information":[{"code":"CP17744631831146848","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756060456","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Tobramycin   Neb 300/5ml","code_information":[{"code":"CP17744631831141222","type":"CDM"},{"code":"250","type":"RC"},{"code":"93408","type":"CPT","modifier":"563"}],"standard_charges":[{"setting":"outpatient","modifier_code":["563"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Clomipramine Cap 25mg","code_information":[{"code":"CP17744631829378068","type":"CDM"},{"code":"250","type":"RC"},{"code":"78120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clozapine    Tab 100/odt","code_information":[{"code":"CP17744631829394024","type":"CDM"},{"code":"250","type":"RC"},{"code":"93541","type":"CPT","modifier":"901"}],"standard_charges":[{"setting":"outpatient","modifier_code":["901"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Nitrofurantn Cap 100mg","code_information":[{"code":"CP17744631830564972","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitrofurantoin Mono Mcr 100mg","code_information":[{"code":"CP17744631830562493","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitroglycerin 0.4mg Subl","code_information":[{"code":"CP17744631830562598","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462063945","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitroglycerin-04mg Subl 25s","code_information":[{"code":"CP17744631830562751","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462063945","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitroglycern Sub 0.4mg","code_information":[{"code":"CP17744631830565292","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462063945","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830870627","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291077360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Skin Barrier Mis 1-3/16\"","code_information":[{"code":"CP17744631831023918","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380007806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ciclopirox   Sol 8%","code_information":[{"code":"CP17744631829221662","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802014167","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Desvenlafax  Tab 100mg Er","code_information":[{"code":"CP17744631829568247","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304019230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluvoxamine  Cap 100mg Er","code_information":[{"code":"CP17744631829980570","type":"CDM"},{"code":"250","type":"RC"},{"code":"22828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluvoxamine Er 100mg Caps","code_information":[{"code":"CP17744631829992355","type":"CDM"},{"code":"250","type":"RC"},{"code":"22828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Urea Nail    Gel 45%","code_information":[{"code":"CP17744631831217106","type":"CDM"},{"code":"250","type":"RC"},{"code":"42808020428","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"1-day 6.5%   Oin Monistat","code_information":[{"code":"CP17744631828079783","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736044101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dressing Change/pvpstk/al","code_information":[{"code":"CP17744631829744591","type":"CDM"},{"code":"250","type":"RC"},{"code":"14704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hc Pramoxine Cre 2.5-1%","code_information":[{"code":"CP17744631830071726","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802047253","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydrocort Crm 2.5%-1%","code_information":[{"code":"CP17744631830113623","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802047253","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lactulose    Sol 10gm/15","code_information":[{"code":"CP17744631830206107","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980059248","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Tobra/dexame Sus 0.3-0.1%","code_information":[{"code":"CP17744631831144856","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Cardizem La  Tab 120mg","code_information":[{"code":"CP17744631829127950","type":"CDM"},{"code":"250","type":"RC"},{"code":"18720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Cardizem La  Tab 120mg","code_information":[{"code":"CP17744631829123602","type":"CDM"},{"code":"250","type":"RC"},{"code":"18720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Duoderm Signal 4\"x4\" Dre","code_information":[{"code":"CP17744631829756703","type":"CDM"},{"code":"250","type":"RC"},{"code":"34033","type":"CPT","modifier":"26"}],"standard_charges":[{"setting":"outpatient","modifier_code":["26"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Theophylline Tab 300mg Er","code_information":[{"code":"CP17744631831125784","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462072101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Atazanavir   Cap 200mg","code_information":[{"code":"CP17744631828779573","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097044503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Dronabinol   Cap 5mg","code_information":[{"code":"CP17744631829741368","type":"CDM"},{"code":"250","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Earwax Removal Drops-6.5%","code_information":[{"code":"CP17744631829765288","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122055705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Gnp Earwax   Sol Removal","code_information":[{"code":"CP17744631830053801","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122055705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Minerin      Cre","code_information":[{"code":"CP17744631830481642","type":"CDM"},{"code":"250","type":"RC"},{"code":"90477","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Minerin Cream","code_information":[{"code":"CP17744631830483279","type":"CDM"},{"code":"250","type":"RC"},{"code":"90477","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Penicilln Gk Inj 5mu","code_information":[{"code":"CP17744631830743933","type":"CDM"},{"code":"250","type":"RC"},{"code":"78161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Pepto Kids Calcium Carb","code_information":[{"code":"CP17744631830759830","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000049024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zanaflex     Cap 2mg","code_information":[{"code":"CP17744631831397538","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515060215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829268522","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lanthanum    Chw 1000mg","code_information":[{"code":"CP17744631830210965","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180082147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Lanthanum Carb 1000mg Chewable","code_information":[{"code":"CP17744631830222636","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180082147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Roflumilast  Tab 250mcg","code_information":[{"code":"CP17744631830919762","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571036983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diltiazem    Tab 120mg Er","code_information":[{"code":"CP17744631829697887","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Huber Needle Mis 22gx1\"","code_information":[{"code":"CP17744631830082456","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Huber Infu Set 22gx1","code_information":[{"code":"CP17744631830170088","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Gel Wound","code_information":[{"code":"CP17744631830404545","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003470","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pantoprazole 40mg/100ml Ns","code_information":[{"code":"CP17744631830730477","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pantoprazole Inj Sod 40mg","code_information":[{"code":"CP17744631830739669","type":"CDM"},{"code":"250","type":"RC"},{"code":"78132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sumatriptan  Tab 100mg","code_information":[{"code":"CP17744631831089175","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111029398","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sumatriptan  Tab 100mg","code_information":[{"code":"CP17744631831086416","type":"CDM"},{"code":"250","type":"RC"},{"code":"42043022209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sumatriptan  Tab 100mg","code_information":[{"code":"CP17744631831081655","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304009919","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sumatriptan  Tab 100mg","code_information":[{"code":"CP17744631831084644","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862014836","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sumatriptan  Tab 50mg","code_information":[{"code":"CP17744631831085705","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714079701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sumatriptan  Tab 50mg","code_information":[{"code":"CP17744631831084949","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862014736","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sumatriptan  Tab 50mg","code_information":[{"code":"CP17744631831085302","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452034572","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Wrap Around Wrist Brace","code_information":[{"code":"CP17744631831384580","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020385","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Atazanavir   Cap 200mg","code_information":[{"code":"CP17744631828772362","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385092160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Sitagliptin  Tab 50mg","code_information":[{"code":"CP17744631831024076","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710190009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ampicillin   Inj 2gm","code_information":[{"code":"CP17744631828524839","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021013720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828520200","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021013720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gm/100ml Ns Mb Kt","code_information":[{"code":"CP17744631828523246","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021013720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Bandage Roll Mis 4.5\"x4yd","code_information":[{"code":"CP17744631828838042","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917007159","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metron/nacl  Inj 500mg","code_information":[{"code":"CP17744631830478627","type":"CDM"},{"code":"250","type":"RC"},{"code":"33810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metronidazol Inj 500mg","code_information":[{"code":"CP17744631830475447","type":"CDM"},{"code":"250","type":"RC"},{"code":"33810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metronidazole 500mg/100ml","code_information":[{"code":"CP17744631830477846","type":"CDM"},{"code":"250","type":"RC"},{"code":"33810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metronidazole-500mg/100ml-soln","code_information":[{"code":"CP17744631830477674","type":"CDM"},{"code":"250","type":"RC"},{"code":"33810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Naratriptan  Tab 1mg","code_information":[{"code":"CP17744631830546558","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155005419","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Naratriptan  Tab 2.5mg","code_information":[{"code":"CP17744631830540622","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155005519","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Rasagiline   Tab 0.5mg","code_information":[{"code":"CP17744631830875516","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714077001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rasagiline   Tab 0.5mg","code_information":[{"code":"CP17744631830872933","type":"CDM"},{"code":"250","type":"RC"},{"code":"93306","type":"CPT","modifier":"56"}],"standard_charges":[{"setting":"outpatient","modifier_code":["56"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rasagiline   Tab 1mg","code_information":[{"code":"CP17744631830873490","type":"CDM"},{"code":"250","type":"RC"},{"code":"93306","type":"CPT","modifier":"156"}],"standard_charges":[{"setting":"outpatient","modifier_code":["156"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Rasagiline   Tab 1mg","code_information":[{"code":"CP17744631830876791","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571022130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Rasagiline 1mg Tabs","code_information":[{"code":"CP17744631830878451","type":"CDM"},{"code":"250","type":"RC"},{"code":"93306","type":"CPT","modifier":"156"}],"standard_charges":[{"setting":"outpatient","modifier_code":["156"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830995746","type":"CDM"},{"code":"250","type":"RC"},{"code":"59122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Triamcinolon Oin 0.1%","code_information":[{"code":"CP17744631831189007","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672128402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Verapamil    Cap 200mg Er","code_information":[{"code":"CP17744631831263466","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175048637","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Doxycycline  Cap 40mg","code_information":[{"code":"CP17744631829746865","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993081530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Reglan       Tab 5mg","code_information":[{"code":"CP17744631830886224","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Budesonide   Cap 3mg Dr","code_information":[{"code":"CP17744631828952680","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162077810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Budesonide Ec 3mg Caps","code_information":[{"code":"CP17744631828965456","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162077810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Fluconazole  Sus 40mg/ml","code_information":[{"code":"CP17744631829963678","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lanthanum    Chw 1000mg","code_information":[{"code":"CP17744631830219984","type":"CDM"},{"code":"250","type":"RC"},{"code":"76282047890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Methylphenid Tab 36mg Er","code_information":[{"code":"CP17744631830452950","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":36,"type":"ME"}},{"description":"Sur-fit Natu Waf 4\"x4\"","code_information":[{"code":"CP17744631831087319","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010177","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hc Pramoxine Cre 1-1%","code_information":[{"code":"CP17744631830075383","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802014464","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pyridostigmi Tab Er 180mg","code_information":[{"code":"CP17744631830852289","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781033530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Pyridostigmi Tab Er 180mg","code_information":[{"code":"CP17744631830855389","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682030130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831175501","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714013025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Welchol      Tab 625mg","code_information":[{"code":"CP17744631831370159","type":"CDM"},{"code":"250","type":"RC"},{"code":"65597070118","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Cozaar       Tab 50mg","code_information":[{"code":"CP17744631829427403","type":"CDM"},{"code":"250","type":"RC"},{"code":"60952","type":"CPT","modifier":"31"}],"standard_charges":[{"setting":"outpatient","modifier_code":["31"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dextrose     Inj 5%","code_information":[{"code":"CP17744631829582086","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829994001","type":"CDM"},{"code":"250","type":"RC"},{"code":"93406","type":"CPT","modifier":"106"}],"standard_charges":[{"setting":"outpatient","modifier_code":["106"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Leucovor Ca  Tab 25mg","code_information":[{"code":"CP17744631830292599","type":"CDM"},{"code":"250","type":"RC"},{"code":"54449","type":"CPT","modifier":"911"}],"standard_charges":[{"setting":"outpatient","modifier_code":["911"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Polymyxin B  Inj 500000","code_information":[{"code":"CP17744631830781561","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500000,"type":"EA"}},{"description":"Atropine Sul Sol 1% Op","code_information":[{"code":"CP17744631828796725","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603026402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Constulose   Sol 10gm/15","code_information":[{"code":"CP17744631829419910","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963043963","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Doxycyc Mono Cap 150mg","code_information":[{"code":"CP17744631829736117","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380018101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Neo/poly/gra Sol Op","code_information":[{"code":"CP17744631830547373","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208079062","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Tab 40mg Er","code_information":[{"code":"CP17744631830713998","type":"CDM"},{"code":"250","type":"RC"},{"code":"93573","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Thalitone    Tab 15mg","code_information":[{"code":"CP17744631831127176","type":"CDM"},{"code":"250","type":"RC"},{"code":"70199001730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Allevyn Gent Pad 4\"x4","code_information":[{"code":"CP17744631828415862","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829740278","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806031205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dronabinol   Cap 2.5mg","code_information":[{"code":"CP17744631829746168","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687037501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Gentamicin   Inj 10mg/ml","code_information":[{"code":"CP17744631830021879","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Glucose Sos  Pow","code_information":[{"code":"CP17744631830045989","type":"CDM"},{"code":"250","type":"RC"},{"code":"65702000030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830665248","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505056000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Tab 20mg Er","code_information":[{"code":"CP17744631830717285","type":"CDM"},{"code":"250","type":"RC"},{"code":"11515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830716914","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858000501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone 30mg Tabs","code_information":[{"code":"CP17744631830717992","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858000501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ropinirole   Tab 6mg Er","code_information":[{"code":"CP17744631830916814","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111072730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Zolmitriptan Tab 5mg","code_information":[{"code":"CP17744631831407530","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980020413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Imipram Pam  Cap 150mg","code_information":[{"code":"CP17744631830130681","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180031706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Nystatin     Pow 100000","code_information":[{"code":"CP17744631830650532","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Silvercel 2x2 Non-adh Dsg","code_information":[{"code":"CP17744631831025368","type":"CDM"},{"code":"250","type":"RC"},{"code":"75591882689","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sitagliptin  Tab 25mg","code_information":[{"code":"CP17744631831028801","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710189903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831263839","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799096101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Esomeprazole Gra 20mg Dr","code_information":[{"code":"CP17744631829810733","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382084894","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Levothyroxin Cap 13mcg","code_information":[{"code":"CP17744631830316883","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":13,"type":"ME"}},{"description":"Paliperidone Tab Er 6mg","code_information":[{"code":"CP17744631830723210","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722031930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Propafenone  Cap 225mg Er","code_information":[{"code":"CP17744631830843503","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Tretinoin    Gel 0.025%","code_information":[{"code":"CP17744631831174805","type":"CDM"},{"code":"250","type":"RC"},{"code":"57423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Amantadine   Sol 50mg/5ml","code_information":[{"code":"CP17744631828450179","type":"CDM"},{"code":"250","type":"RC"},{"code":"12106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Amantadine   Syp 50mg/5ml","code_information":[{"code":"CP17744631828452605","type":"CDM"},{"code":"250","type":"RC"},{"code":"12106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Benadryl     Cre 1-0.1%","code_information":[{"code":"CP17744631828854275","type":"CDM"},{"code":"250","type":"RC"},{"code":"12547017162","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carospir     Sus 25mg/5ml","code_information":[{"code":"CP17744631829137272","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287002004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"D5w/0.45ns/20meq Kcl","code_information":[{"code":"CP17744631829453934","type":"CDM"},{"code":"250","type":"RC"},{"code":"33806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kcl 20meq In D5w/ 0.45% Ns","code_information":[{"code":"CP17744631830182946","type":"CDM"},{"code":"250","type":"RC"},{"code":"33806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kcl/d5w/nacl Inj","code_information":[{"code":"CP17744631830186204","type":"CDM"},{"code":"250","type":"RC"},{"code":"33806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexmethylph  Cap 30mg Er","code_information":[{"code":"CP17744631829577922","type":"CDM"},{"code":"250","type":"RC"},{"code":"93555","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Dexmethylphenidate Er 30mg Cap","code_information":[{"code":"CP17744631829574470","type":"CDM"},{"code":"250","type":"RC"},{"code":"93555","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lidocaine    Pad 4%","code_information":[{"code":"CP17744631830334883","type":"CDM"},{"code":"250","type":"RC"},{"code":"73317686605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831136292","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742028860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bupren/nalox Mis 8-2mg","code_information":[{"code":"CP17744631828977218","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598058230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Chlorhex Glu Pad 2%","code_information":[{"code":"CP17744631829216921","type":"CDM"},{"code":"250","type":"RC"},{"code":"53462070520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eakin Cohesv Mis Seals 2\"","code_information":[{"code":"CP17744631829769152","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010873","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol    Tab 10mcg","code_information":[{"code":"CP17744631829822040","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estradiol 10mcg Vag Tabs","code_information":[{"code":"CP17744631829827951","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071171","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estradiol 10mcg Vagin Inserts","code_information":[{"code":"CP17744631829825984","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estradiol 10mcg Vagin Inserts","code_information":[{"code":"CP17744631829827195","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071171","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estradiol 10mcg Vaginal Insert","code_information":[{"code":"CP17744631829828023","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estradiol Vag Ins 10mcg Tabs","code_information":[{"code":"CP17744631829825102","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Febuxostat   Tab 80mg","code_information":[{"code":"CP17744631829847910","type":"CDM"},{"code":"250","type":"RC"},{"code":"37839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Hydromorphon Inj 2mg/ml","code_information":[{"code":"CP17744631830116696","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830816608","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687050601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830998330","type":"CDM"},{"code":"250","type":"RC"},{"code":"59122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"T.e.d Stocking K-h Large","code_information":[{"code":"CP17744631831099769","type":"CDM"},{"code":"250","type":"RC"},{"code":"11141","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tria/nys/zinc/lido","code_information":[{"code":"CP17744631831170218","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triam 0.1% Bacitracin 500u/g","code_information":[{"code":"CP17744631831171023","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"UN"}},{"description":"Triamcinolon Oin 0.1%","code_information":[{"code":"CP17744631831187825","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinolone 0.1% / Cetaphil","code_information":[{"code":"CP17744631831183340","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zn20/nyo/tro0.1/lidc4 2:1:1:1","code_information":[{"code":"CP17744631831404540","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cold/hot Pack Reusable","code_information":[{"code":"CP17744631829403435","type":"CDM"},{"code":"250","type":"RC"},{"code":"74676066111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ethacrynic   Tab Acd 25mg","code_information":[{"code":"CP17744631829823669","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238112601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fenofibric   Cap 135mg Dr","code_information":[{"code":"CP17744631829857649","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332024590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":135,"type":"ME"}},{"description":"Lidocaine    Inj 1%","code_information":[{"code":"CP17744631830332711","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 1% Inj","code_information":[{"code":"CP17744631830336223","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rivastigmine 4.5mg Caps","code_information":[{"code":"CP17744631830908193","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Rivastigmine Cap 4.5mg","code_information":[{"code":"CP17744631830902141","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Testost Cyp  Inj 100mg/ml","code_information":[{"code":"CP17744631831119925","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756001740","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828511604","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993059502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Candesartan  Tab 32mg","code_information":[{"code":"CP17744631829098882","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342011707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Vancomycin 1.25gm/250ml Ns Vm","code_information":[{"code":"CP17744631831231270","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Vancomycin 1250mg/ 250ml El-l","code_information":[{"code":"CP17744631831247976","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Vancomycin 1250mg/250ml Elasto","code_information":[{"code":"CP17744631831242537","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Vancomycin 1250mg/250ml El-j","code_information":[{"code":"CP17744631831248415","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Vancomycin 1250mg/250ml El-l","code_information":[{"code":"CP17744631831243739","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457082312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1250,"type":"ME"}},{"description":"Anagrelide   Cap 1mg","code_information":[{"code":"CP17744631828535866","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668046201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Anagrelide   Cap 1mg","code_information":[{"code":"CP17744631828537944","type":"CDM"},{"code":"250","type":"RC"},{"code":"17252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bupren/nalox Mis 4-1mg","code_information":[{"code":"CP17744631828970158","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598058030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fenofibrate  Tab 40mg","code_information":[{"code":"CP17744631829857976","type":"CDM"},{"code":"250","type":"RC"},{"code":"37843","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluconazole  Tab 200mg","code_information":[{"code":"CP17744631829969581","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Sur-fit Natura Stoma 401575","code_information":[{"code":"CP17744631831082361","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010377","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupren/nalox Mis 8-2mg","code_information":[{"code":"CP17744631828973034","type":"CDM"},{"code":"250","type":"RC"},{"code":"37887","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Chap Stick","code_information":[{"code":"CP17744631829207464","type":"CDM"},{"code":"250","type":"RC"},{"code":"30573070112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 50mg Odt","code_information":[{"code":"CP17744631830214977","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lamotrigine 50mg Odt","code_information":[{"code":"CP17744631830212842","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lyvispah     Gra 10mg","code_information":[{"code":"CP17744631830394863","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896007709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lyvispah     Gra 20mg","code_information":[{"code":"CP17744631830391128","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896007809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lyvispah     Gra 5mg","code_information":[{"code":"CP17744631830393666","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896007609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Neo/poly/hc  Sol 1% Otic","code_information":[{"code":"CP17744631830545135","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208063110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Cap 5mg","code_information":[{"code":"CP17744631831091683","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tacrolimus 0.5mg/ml Oral Susp","code_information":[{"code":"CP17744631831093073","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Varenicline  Tab 1mg","code_information":[{"code":"CP17744631831247451","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505361405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ethacrynic   Tab Acd 25mg","code_information":[{"code":"CP17744631829820319","type":"CDM"},{"code":"250","type":"RC"},{"code":"83216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ethacrynic   Tab Acd 25mg","code_information":[{"code":"CP17744631829829702","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228033410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lorazepam    Inj 2mg/ml","code_information":[{"code":"CP17744631830369635","type":"CDM"},{"code":"250","type":"RC"},{"code":"40919","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Desvenlafax  Tab 50mg Er","code_information":[{"code":"CP17744631829579643","type":"CDM"},{"code":"250","type":"RC"},{"code":"54040","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Levothyroxin Cap 125mcg","code_information":[{"code":"CP17744631830314670","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Levothyroxin Cap 200mcg","code_information":[{"code":"CP17744631830312388","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Levothyroxin Cap 25mcg","code_information":[{"code":"CP17744631830318132","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levothyroxine  125mcg Caps","code_information":[{"code":"CP17744631830321757","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831099874","type":"CDM"},{"code":"250","type":"RC"},{"code":"16804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zanaflex     Tab 4mg","code_information":[{"code":"CP17744631831392763","type":"CDM"},{"code":"250","type":"RC"},{"code":"70515059415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Chantix 0.5mg Tabs","code_information":[{"code":"CP17744631829204191","type":"CDM"},{"code":"250","type":"RC"},{"code":"69046","type":"CPT","modifier":"856"}],"standard_charges":[{"setting":"outpatient","modifier_code":["856"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chantix 1mg Tabs","code_information":[{"code":"CP17744631829204499","type":"CDM"},{"code":"250","type":"RC"},{"code":"69046","type":"CPT","modifier":"956"}],"standard_charges":[{"setting":"outpatient","modifier_code":["956"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Insyte Autog Mis 22gx1\"","code_information":[{"code":"CP17744631830150766","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381423","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insyte Autoguard 22g X 1\" Cath","code_information":[{"code":"CP17744631830155277","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381423","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levothyroxin Cap 100mcg","code_information":[{"code":"CP17744631830318625","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxin Cap 50mcg","code_information":[{"code":"CP17744631830317949","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Levothyroxine 50mcg Caps","code_information":[{"code":"CP17744631830320844","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Methylphenid Tab 54mg Er","code_information":[{"code":"CP17744631830457109","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":54,"type":"ME"}},{"description":"Miconazole 7 Cre 2%","code_information":[{"code":"CP17744631830484512","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269073041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":7,"type":"EA"}},{"description":"Pilocarpine  Sol 2% Op","code_information":[{"code":"CP17744631830773803","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238174608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Chlorpromazi Con 30mg/ml","code_information":[{"code":"CP17744631829222919","type":"CDM"},{"code":"250","type":"RC"},{"code":"78140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Minoxidil    Tab 2.5mg","code_information":[{"code":"CP17744631830497875","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084020401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amiodarone   Tab 200mg","code_information":[{"code":"CP17744631828472998","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300035916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Aliskiren    Tab 300mg","code_information":[{"code":"CP17744631828407012","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993014230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ceftaz1gm/100ml Ns","code_information":[{"code":"CP17744631829170026","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime  Inj 1gm","code_information":[{"code":"CP17744631829174431","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/100 Ml Ns","code_information":[{"code":"CP17744631829175192","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/50ml","code_information":[{"code":"CP17744631829172889","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/50ml D5w","code_information":[{"code":"CP17744631829178084","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/50ml Ns","code_information":[{"code":"CP17744631829174260","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/50ml Ns Mb","code_information":[{"code":"CP17744631829177556","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 500mg/50ml","code_information":[{"code":"CP17744631829173778","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ceftazidime 500mg/50ml Nss","code_information":[{"code":"CP17744631829178778","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567023525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Colostomy Pouch Two-piece","code_information":[{"code":"CP17744631829414234","type":"CDM"},{"code":"250","type":"RC"},{"code":"40097","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluvastatin  Tab 80mg Er","code_information":[{"code":"CP17744631829987116","type":"CDM"},{"code":"250","type":"RC"},{"code":"93744","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Octreotide   Inj 50mcg/ml","code_information":[{"code":"CP17744631830664161","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457023901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830667972","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505056001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ace Self-adh Mis Bndg 3\"","code_information":[{"code":"CP17744631828181922","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131020369","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cozaar       Tab 25mg","code_information":[{"code":"CP17744631829429698","type":"CDM"},{"code":"250","type":"RC"},{"code":"78206012101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Gnp Zinc Oxi Oin 20%","code_information":[{"code":"CP17744631830057669","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122067646","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Huber Needle Mis 20gx1.5\"","code_information":[{"code":"CP17744631830084443","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Huber Needle Mis 22gx3/4\"","code_information":[{"code":"CP17744631830087470","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lansoprazole Tab 30mg","code_information":[{"code":"CP17744631830214139","type":"CDM"},{"code":"250","type":"RC"},{"code":"93300","type":"CPT","modifier":"993"}],"standard_charges":[{"setting":"outpatient","modifier_code":["993"],"minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Methenam Man Tab 1gm","code_information":[{"code":"CP17744631830443302","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925010701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Pancreaze    Cap 10500unt","code_information":[{"code":"CP17744631830735637","type":"CDM"},{"code":"250","type":"RC"},{"code":"62541040310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":10500,"type":"EA"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830816610","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Silver Alginate Dress 2x2","code_information":[{"code":"CP17744631831015643","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclopentol  Sol 1% Op","code_information":[{"code":"CP17744631829449775","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478010002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diltiazem    Tab 120mg Er","code_information":[{"code":"CP17744631829691051","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436019504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Droxidopa    Cap 100mg","code_information":[{"code":"CP17744631829758844","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205007290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Eszopiclone  Tab 2mg","code_information":[{"code":"CP17744631829828186","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111061901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Eszopiclone  Tab 2mg","code_information":[{"code":"CP17744631829826921","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862096801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Fluvoxamine  Cap 150mg Er","code_information":[{"code":"CP17744631829983449","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241027530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830991543","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802058084","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Scopolamine 1mg/3days Patch","code_information":[{"code":"CP17744631830996332","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802058084","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tegaderm Flm Mis Frame St","code_information":[{"code":"CP17744631831103836","type":"CDM"},{"code":"250","type":"RC"},{"code":"35356018550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Topiramate   Cap Er 50mg","code_information":[{"code":"CP17744631831156824","type":"CDM"},{"code":"250","type":"RC"},{"code":"83210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3,"maximum":4,"gross_charge":4,"discounted_cash":4,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":4},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Flonase Sens Sus 27.5mcg","code_information":[{"code":"CP17744631829966743","type":"CDM"},{"code":"250","type":"RC"},{"code":"13506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":275,"type":"ME"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830771933","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Valacyclovir Tab 1gm","code_information":[{"code":"CP17744631831217897","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Calcium Alg Dress 4x4","code_information":[{"code":"CP17744631829072176","type":"CDM"},{"code":"250","type":"RC"},{"code":"90202","type":"CPT","modifier":"44"}],"standard_charges":[{"setting":"outpatient","modifier_code":["44"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Coban Lf Wrp Mis 4\"x5yds","code_information":[{"code":"CP17744631829393246","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333208410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl 25mcg/hr Patch","code_information":[{"code":"CP17744631829851797","type":"CDM"},{"code":"250","type":"RC"},{"code":"40690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Synthroid    Tab 75mcg","code_information":[{"code":"CP17744631831088847","type":"CDM"},{"code":"250","type":"RC"},{"code":"74518","type":"CPT","modifier":"290"}],"standard_charges":[{"setting":"outpatient","modifier_code":["290"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Moxifloxacin Sol 0.5%","code_information":[{"code":"CP17744631830516241","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Chloraseptic Loz 6-10mg","code_information":[{"code":"CP17744631829217814","type":"CDM"},{"code":"250","type":"RC"},{"code":"78112001106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Chloraseptic Loz Citrus","code_information":[{"code":"CP17744631829217285","type":"CDM"},{"code":"250","type":"RC"},{"code":"78112001266","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluorouracil Cre 5%","code_information":[{"code":"CP17744631829978879","type":"CDM"},{"code":"250","type":"RC"},{"code":"37847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Iv Filtered Ext Set 1.2mi","code_information":[{"code":"CP17744631830174879","type":"CDM"},{"code":"250","type":"RC"},{"code":"8021470117","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metanx Fc    Cap","code_information":[{"code":"CP17744631830439391","type":"CDM"},{"code":"250","type":"RC"},{"code":"52581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine Sul Cap 30mg Er","code_information":[{"code":"CP17744631830509684","type":"CDM"},{"code":"250","type":"RC"},{"code":"83202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Urost Pouch  Mis 1-3/4\"","code_information":[{"code":"CP17744631831211893","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010369","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Drospire/eth Tab Estr/lev","code_information":[{"code":"CP17744631829748230","type":"CDM"},{"code":"250","type":"RC"},{"code":"78140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metafolbic   Tab Plus Rf","code_information":[{"code":"CP17744631830439400","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991091133","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Quetiapine   Tab 300mg Er","code_information":[{"code":"CP17744631830868604","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228038360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg Er","code_information":[{"code":"CP17744631830864220","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180061507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg Er","code_information":[{"code":"CP17744631830861071","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729009612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg Er","code_information":[{"code":"CP17744631830861425","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342013609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg Er","code_information":[{"code":"CP17744631830861029","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine Er 300mg Tabs","code_information":[{"code":"CP17744631830868667","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729009612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine Er 300mg Tabs","code_information":[{"code":"CP17744631830866257","type":"CDM"},{"code":"250","type":"RC"},{"code":"71093013802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830995567","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742050510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830994978","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742050524","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Heparin Lock Inj 10unt/ml","code_information":[{"code":"CP17744631830076893","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Methylphenid Tab 18mg Er","code_information":[{"code":"CP17744631830458639","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175031037","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Opium        Tin 10mg/ml","code_information":[{"code":"CP17744631830699136","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559015304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829213059","type":"CDM"},{"code":"250","type":"RC"},{"code":"52729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829214565","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238106201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829216283","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829217809","type":"CDM"},{"code":"250","type":"RC"},{"code":"90096013501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829216007","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304008301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Norliqva     Sol 1mg/ml","code_information":[{"code":"CP17744631830574743","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287003515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Pramosone    Lot 1%","code_information":[{"code":"CP17744631830808896","type":"CDM"},{"code":"250","type":"RC"},{"code":"54766072904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sevelamer    Pow 2.4gm","code_information":[{"code":"CP17744631831007403","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Sevelamer 2.4gm Packets","code_information":[{"code":"CP17744631831013588","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Fluvastatin  Cap 20mg","code_information":[{"code":"CP17744631829985877","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lancing Device","code_information":[{"code":"CP17744631830218886","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151014201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levothyroxin Cap 112mcg","code_information":[{"code":"CP17744631830319090","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":112,"type":"ME"}},{"description":"Levothyroxin Cap 137mcg","code_information":[{"code":"CP17744631830313074","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Levothyroxin Cap 175mcg","code_information":[{"code":"CP17744631830311632","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":175,"type":"ME"}},{"description":"Levothyroxine  Caps 112mcg","code_information":[{"code":"CP17744631830323273","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":112,"type":"ME"}},{"description":"Levothyroxine 137mcg Caps","code_information":[{"code":"CP17744631830325527","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Truedraw     Mis Lanc Dev","code_information":[{"code":"CP17744631831195113","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151014201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flovent Disk 100mcg 60 Inh","code_information":[{"code":"CP17744631829967410","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Flovent Disk Aer 100mcg","code_information":[{"code":"CP17744631829962845","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Nebivolol    Tab 2.5mg","code_information":[{"code":"CP17744631830542932","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olanza/fluox 12-50mg Caps","code_information":[{"code":"CP17744631830667401","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884025311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830105195","type":"CDM"},{"code":"250","type":"RC"},{"code":"72056001012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830107779","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571067621","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830114560","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494030112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrocortisone 25mg Supp","code_information":[{"code":"CP17744631830113590","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tegretol-xr  Tab 200mg","code_information":[{"code":"CP17744631831108229","type":"CDM"},{"code":"250","type":"RC"},{"code":"78051","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831137456","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Chlorzoxazon Tab 750mg","code_information":[{"code":"CP17744631829224300","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571072701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Dexmethylphe Cap 20mg Er","code_information":[{"code":"CP17744631829577252","type":"CDM"},{"code":"250","type":"RC"},{"code":"93555","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Dexmethylphe Cap 20mg Er","code_information":[{"code":"CP17744631829575295","type":"CDM"},{"code":"250","type":"RC"},{"code":"11599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Duoderm Cgf  Mis 2\"x4\"","code_information":[{"code":"CP17744631829755276","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010277","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Sus 100000","code_information":[{"code":"CP17744631830656406","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689003799","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Nystatin 500000unit/5ml Susp","code_information":[{"code":"CP17744631830659219","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689003799","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500000,"type":"UN"}},{"description":"Pilocarpine  Sol 4% Op","code_information":[{"code":"CP17744631830775508","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238174708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Piper/tazoba Inj 4-0.5gm","code_information":[{"code":"CP17744631830780401","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Asenapine    Sub 10mg","code_information":[{"code":"CP17744631828760416","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332019931","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Asenapine    Sub 10mg","code_information":[{"code":"CP17744631828760220","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332019960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Asenapine    Sub 5mg","code_information":[{"code":"CP17744631828768188","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332019831","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Asenapine    Sub 5mg","code_information":[{"code":"CP17744631828766898","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332019860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Budesonide   Sus 1mg/2ml","code_information":[{"code":"CP17744631828968453","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097032187","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyclosporine Cap 25mg","code_information":[{"code":"CP17744631829441143","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505013300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dronabinol   Cap 10mg","code_information":[{"code":"CP17744631829745052","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478076306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Colesevelam  Pak 3.75","code_information":[{"code":"CP17744631829400640","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660099530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Colesevelam  Pak 3.75gm","code_information":[{"code":"CP17744631829408725","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462062030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Colesevelam  Pak 3.75gm","code_information":[{"code":"CP17744631829406652","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660099530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Colesevelam  Pak 3.75gm","code_information":[{"code":"CP17744631829409355","type":"CDM"},{"code":"250","type":"RC"},{"code":"71309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Lamotrigine  Tab 300mg Er","code_information":[{"code":"CP17744631830213137","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Levothyroxin Cap 150mcg","code_information":[{"code":"CP17744631830317841","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Levothyroxine  150mcg Caps","code_information":[{"code":"CP17744631830321073","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Phenergan    Inj 25mg/ml","code_information":[{"code":"CP17744631830753698","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Aminocapr Ac Tab 500mg","code_information":[{"code":"CP17744631828465240","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559022530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Steril Water Inj","code_information":[{"code":"CP17744631831066167","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sterile      Inj Water","code_information":[{"code":"CP17744631831062013","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sterile Water For Injecti","code_information":[{"code":"CP17744631831068812","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Theophylline Tab 100mg Er","code_information":[{"code":"CP17744631831129078","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033005701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Aliskiren    Tab 150mg","code_information":[{"code":"CP17744631828405506","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884042411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Azithromycin Tab 600mg","code_information":[{"code":"CP17744631828812476","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Chlorpromaz  Tab 200mg","code_information":[{"code":"CP17744631829212135","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Dutast/tamsu Cap 0.5-0.4","code_information":[{"code":"CP17744631829761257","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382064006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Iv 4 Way Extension Set","code_information":[{"code":"CP17744631830178872","type":"CDM"},{"code":"250","type":"RC"},{"code":"81286","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxcarbazepin Tab 300mg","code_information":[{"code":"CP17744631830700559","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756018418","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Oxcarbazepine 300mg Tabs","code_information":[{"code":"CP17744631830705183","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756018418","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Urost Pouch  Mis 1-1/2\"","code_information":[{"code":"CP17744631831210625","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010351","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Walker Ski   Mis Glide/1\"","code_information":[{"code":"CP17744631831300697","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601045280","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Baclofen     Tab 10mg","code_information":[{"code":"CP17744631828829689","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Baclofen 10mg Tabs","code_information":[{"code":"CP17744631828837511","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829219314","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205010691","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tacrolimus   Cap 5mg","code_information":[{"code":"CP17744631831097806","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729004301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tacrolimus   Cap 5mg","code_information":[{"code":"CP17744631831097842","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tacrolimus   Cap 5mg","code_information":[{"code":"CP17744631831094784","type":"CDM"},{"code":"250","type":"RC"},{"code":"37820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tacrolimus   Cap 5mg","code_information":[{"code":"CP17744631831098036","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111052701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Allopurinol  Tab 200mg","code_information":[{"code":"CP17744631828420320","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315040909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Calcipotrien Oin Betameth","code_information":[{"code":"CP17744631829065472","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Depend P/u Max Large Women","code_information":[{"code":"CP17744631829555176","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000038531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Depend Undr  Mis Large","code_information":[{"code":"CP17744631829555436","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000038531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diazepam     Inj 50/10ml","code_information":[{"code":"CP17744631829582670","type":"CDM"},{"code":"250","type":"RC"},{"code":"69339013705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Huber Needle Set/22gx1\"","code_information":[{"code":"CP17744631830082789","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126958","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Infusion Set Mis 20gx1\"","code_information":[{"code":"CP17744631830143408","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126954","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Infusion Set Mis 22gx3/4\"","code_information":[{"code":"CP17744631830141833","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126959","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Meclofen Sod Cap 50mg","code_information":[{"code":"CP17744631830404775","type":"CDM"},{"code":"250","type":"RC"},{"code":"37821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nicardipine  Cap 30mg","code_information":[{"code":"CP17744631830555676","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806050209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pacerone     Tab 400mg","code_information":[{"code":"CP17744631830726253","type":"CDM"},{"code":"250","type":"RC"},{"code":"24516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Palmers      Cre Cocoa","code_information":[{"code":"CP17744631830738017","type":"CDM"},{"code":"250","type":"RC"},{"code":"10181004350","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paricalcitol Cap 2 Mcg","code_information":[{"code":"CP17744631830733718","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452014613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Paricalcitol Cap 2 Mcg","code_information":[{"code":"CP17744631830739099","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Paricalcitol Cap 2 Mcg","code_information":[{"code":"CP17744631830737729","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382033106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831179651","type":"CDM"},{"code":"250","type":"RC"},{"code":"81298578303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Cevimeline   Cap 30mg","code_information":[{"code":"CP17744631829200917","type":"CDM"},{"code":"250","type":"RC"},{"code":"54033","type":"CPT","modifier":"425"}],"standard_charges":[{"setting":"outpatient","modifier_code":["425"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Isoniazid    Tab 300mg","code_information":[{"code":"CP17744631830162798","type":"CDM"},{"code":"250","type":"RC"},{"code":"81665010830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Metamucil    Cap 0.36gm","code_information":[{"code":"CP17744631830433983","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000040511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":36,"type":"GR"}},{"description":"Metamucil 0.4gm Caps","code_information":[{"code":"CP17744631830432623","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000040511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Methylphenid Cap 10mg Er","code_information":[{"code":"CP17744631830440925","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezallor Spr  Cap 10mg","code_information":[{"code":"CP17744631829835812","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335098583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezallor Spr  Cap 20mg","code_information":[{"code":"CP17744631829837326","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335098683","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ezallor Spr  Cap 40mg","code_information":[{"code":"CP17744631829839133","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335098783","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluconazole  Tab 200mg","code_information":[{"code":"CP17744631829968601","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135013330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ipratrop/albut 0.5-3mg Inh Sol","code_information":[{"code":"CP17744631830151932","type":"CDM"},{"code":"250","type":"RC"},{"code":"48702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830166494","type":"CDM"},{"code":"250","type":"RC"},{"code":"48702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Cadd Extension Set","code_information":[{"code":"CP17744631830179244","type":"CDM"},{"code":"250","type":"RC"},{"code":"21704","type":"CPT","modifier":"724"}],"standard_charges":[{"setting":"outpatient","modifier_code":["724"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Modafinil    Tab 100mg","code_information":[{"code":"CP17744631830496580","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Polymem Cloth Dress 2x4","code_information":[{"code":"CP17744631830786642","type":"CDM"},{"code":"250","type":"RC"},{"code":"8195704201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Polymem Clth Mis Drsg 4x2","code_information":[{"code":"CP17744631830780181","type":"CDM"},{"code":"250","type":"RC"},{"code":"8195704201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pradaxa      Cap 110mg","code_information":[{"code":"CP17744631830804164","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":110,"type":"ME"}},{"description":"Pradaxa      Cap 75mg","code_information":[{"code":"CP17744631830809846","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pradaxa 75mg Cap *Whole Btle*","code_information":[{"code":"CP17744631830800023","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pradaxa 75mg Caps","code_information":[{"code":"CP17744631830804934","type":"CDM"},{"code":"250","type":"RC"},{"code":"59703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Ursodiol     Cap 300mg","code_information":[{"code":"CP17744631831219546","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806050301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ace Elastic  Mis Bndg 3\"","code_information":[{"code":"CP17744631828185265","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131021205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clarithromyc Tab 500mg Er","code_information":[{"code":"CP17744631829248616","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Fentanyl     Dis 12mcg/hr","code_information":[{"code":"CP17744631829859784","type":"CDM"},{"code":"250","type":"RC"},{"code":"40690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Levothyroxin Cap 75mcg","code_information":[{"code":"CP17744631830313228","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Levothyroxine 75mcg Caps","code_information":[{"code":"CP17744631830329469","type":"CDM"},{"code":"250","type":"RC"},{"code":"52749","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830725016","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975035203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830722126","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180052606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Tiagabine    Tab 12mg","code_information":[{"code":"CP17744631831124070","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205008630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Urinary      Mis Bag","code_information":[{"code":"CP17744631831219152","type":"CDM"},{"code":"250","type":"RC"},{"code":"8395099030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acampro Cal  Tab 333mg","code_information":[{"code":"CP17744631828159823","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382056928","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":333,"type":"ME"}},{"description":"Dabigatran   Cap 75mg","code_information":[{"code":"CP17744631829467130","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505434706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Promethazine Inj 50mg/ml","code_information":[{"code":"CP17744631830843302","type":"CDM"},{"code":"250","type":"RC"},{"code":"64109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Repaglinide  Tab 1mg","code_information":[{"code":"CP17744631830887525","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Armodafinil  Tab 150mg","code_information":[{"code":"CP17744631828751034","type":"CDM"},{"code":"250","type":"RC"},{"code":"37834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Armodafinil  Tab 200mg","code_information":[{"code":"CP17744631828754585","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862099830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Armodafinil  Tab 200mg","code_information":[{"code":"CP17744631828757480","type":"CDM"},{"code":"250","type":"RC"},{"code":"93309","type":"CPT","modifier":"356"}],"standard_charges":[{"setting":"outpatient","modifier_code":["356"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Armodafinil  Tab 250mg","code_information":[{"code":"CP17744631828751169","type":"CDM"},{"code":"250","type":"RC"},{"code":"93309","type":"CPT","modifier":"456"}],"standard_charges":[{"setting":"outpatient","modifier_code":["456"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Armodafinil  Tab 250mg","code_information":[{"code":"CP17744631828752202","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Armodafinil 150mg Tabs","code_information":[{"code":"CP17744631828750836","type":"CDM"},{"code":"250","type":"RC"},{"code":"93309","type":"CPT","modifier":"256"}],"standard_charges":[{"setting":"outpatient","modifier_code":["256"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Calcium Alginate 4x4 Dressing","code_information":[{"code":"CP17744631829077988","type":"CDM"},{"code":"250","type":"RC"},{"code":"10075009937","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carbidopa    Tab 25mg","code_information":[{"code":"CP17744631829129795","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651014601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carbidopa    Tab 25mg","code_information":[{"code":"CP17744631829129171","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781033201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ipratropium/ Sol Albuter","code_information":[{"code":"CP17744631830156457","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097084087","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lyvispah     Gra 10mg","code_information":[{"code":"CP17744631830391326","type":"CDM"},{"code":"250","type":"RC"},{"code":"70257041487","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lyvispah     Gra 20mg","code_information":[{"code":"CP17744631830399628","type":"CDM"},{"code":"250","type":"RC"},{"code":"70257041687","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lyvispah     Gra 5mg","code_information":[{"code":"CP17744631830396101","type":"CDM"},{"code":"250","type":"RC"},{"code":"70257041287","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Methylp Ss 125mg/50ml Ns","code_information":[{"code":"CP17744631830448973","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598012925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Methylpr Ss  Inj 125mg","code_information":[{"code":"CP17744631830458317","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598012925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Mucinex      Tab 1200mg","code_information":[{"code":"CP17744631830510812","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824002335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Ozobax       Sol 5mg/5ml","code_information":[{"code":"CP17744631830724589","type":"CDM"},{"code":"250","type":"RC"},{"code":"69528030116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830781228","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml D5w","code_information":[{"code":"CP17744631830784340","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830782670","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Pipera/tazo 3.375 Gm/100 Ml D5","code_information":[{"code":"CP17744631830789201","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Diltiazem    Tab 360mg Er","code_information":[{"code":"CP17744631829694526","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436019904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Diltiazem Er Tab 300mg","code_information":[{"code":"CP17744631829707254","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Voriconazole 40mg/ml Susr","code_information":[{"code":"CP17744631831309837","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762093503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Zolpidem Tar Sub 3.5mg","code_information":[{"code":"CP17744631831416534","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884089911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Advair Disku Aer 250/50","code_information":[{"code":"CP17744631828356836","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Advair Diskus 250/50mcg 60 Inh","code_information":[{"code":"CP17744631828352851","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Advair Diskus 250/50mcg Inh","code_information":[{"code":"CP17744631828350494","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ceftaz1gm/100ml Ns","code_information":[{"code":"CP17744631829172948","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime  Inj 1gm","code_information":[{"code":"CP17744631829177891","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1 Gm/50 Ml Ns","code_information":[{"code":"CP17744631829175604","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm In 100 Ml Ns","code_information":[{"code":"CP17744631829179529","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/100 Ml Ns","code_information":[{"code":"CP17744631829175930","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/100ml Ns","code_information":[{"code":"CP17744631829173306","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 1gm/50ml Ns","code_information":[{"code":"CP17744631829177412","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ceftazidime 3gm/100ml Ns","code_information":[{"code":"CP17744631829173119","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ceftazidime 50mg/ml Opth. Susp","code_information":[{"code":"CP17744631829177279","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lansoprazole Tab 15mg Odt","code_information":[{"code":"CP17744631830216757","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382077177","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Metolazone   Tab 5mg","code_information":[{"code":"CP17744631830455341","type":"CDM"},{"code":"250","type":"RC"},{"code":"18500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metolazone 5mg Tabs","code_information":[{"code":"CP17744631830467105","type":"CDM"},{"code":"250","type":"RC"},{"code":"18500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Advair Disku Aer 100/50","code_information":[{"code":"CP17744631828359937","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Advair Disku Aer 250/50","code_information":[{"code":"CP17744631828356476","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Allevyn Non-adhesive 4x4","code_information":[{"code":"CP17744631828415511","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Drainable Pouch 401534","code_information":[{"code":"CP17744631829740770","type":"CDM"},{"code":"250","type":"RC"},{"code":"36577","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluvastatin  Cap 40mg","code_information":[{"code":"CP17744631829982898","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Muscle Rub   Cre","code_information":[{"code":"CP17744631830526707","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802017453","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Muscle Rub Cream","code_information":[{"code":"CP17744631830528047","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802017453","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nisoldipine  Tab 34mg Er","code_information":[{"code":"CP17744631830566443","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993047502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":34,"type":"ME"}},{"description":"Sirolimus    Tab 1mg","code_information":[{"code":"CP17744631831020196","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762100201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sirolimus 1mg Tabs","code_information":[{"code":"CP17744631831026507","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762100201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Zosyn 13.5g/250ml","code_information":[{"code":"CP17744631831416647","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":135,"type":"GR"}},{"description":"Clarithromyc Tab 500mg Er","code_information":[{"code":"CP17744631829240494","type":"CDM"},{"code":"250","type":"RC"},{"code":"59128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Bedside Drai Kit Coll Sys","code_information":[{"code":"CP17744631828854375","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380009839","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830108243","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571067642","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830100762","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494030124","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ziprasidone  Cap 80mg","code_information":[{"code":"CP17744631831402465","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714083801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Irbesartan   Tab 150mg","code_information":[{"code":"CP17744631830160250","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342004810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lacosamide   Tab 50mg","code_information":[{"code":"CP17744631830202428","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228019260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lamivudine   Tab 150mg","code_information":[{"code":"CP17744631830213745","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380071003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Nebulizer    Kit","code_information":[{"code":"CP17744631830543675","type":"CDM"},{"code":"250","type":"RC"},{"code":"73796039000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac   Cap 25mg","code_information":[{"code":"CP17744631829596138","type":"CDM"},{"code":"250","type":"RC"},{"code":"48094","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ketorolac    Sol 0.5%","code_information":[{"code":"CP17744631830192725","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505100302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ketorolac    Sol 0.5%","code_information":[{"code":"CP17744631830191941","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478020910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Paricalcitol Inj 5mcg/ml","code_information":[{"code":"CP17744631830733331","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729031108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830774845","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862051305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Sirolimus    Tab 0.5mg","code_information":[{"code":"CP17744631831024087","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382052001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Curity Plain Mis Strip","code_information":[{"code":"CP17744631829434468","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080763100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Cap 25mg Mod","code_information":[{"code":"CP17744631829440666","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862045847","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Demeclocycl  Tab 150mg","code_information":[{"code":"CP17744631829555289","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746055401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Hc/acet Acid Sol Otic","code_information":[{"code":"CP17744631830079813","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383090110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thiamine 100mg/ml Vial","code_information":[{"code":"CP17744631831128606","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457019602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Wound Packing Strip 1/2x5","code_information":[{"code":"CP17744631831389393","type":"CDM"},{"code":"250","type":"RC"},{"code":"63234","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Closed Pouch Mis 2\"","code_information":[{"code":"CP17744631829381193","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380003324","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dabigatran   Cap 110mg","code_information":[{"code":"CP17744631829456598","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505434906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":110,"type":"ME"}},{"description":"Drain Pouch  Mis 57mm","code_information":[{"code":"CP17744631829743839","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380018193","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fentanyl     Dis 25mcg/hr","code_information":[{"code":"CP17744631829853955","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fentanyl 25mcg/hr Patch","code_information":[{"code":"CP17744631829854937","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Iodine       Sol Strong","code_information":[{"code":"CP17744631830151488","type":"CDM"},{"code":"250","type":"RC"},{"code":"48433023015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketorolac    Sol 0.5%","code_information":[{"code":"CP17744631830197636","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335022090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clorpactin   Pow Wcs-90","code_information":[{"code":"CP17744631829384819","type":"CDM"},{"code":"250","type":"RC"},{"code":"32700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ferric Glu Inj 12.5mg/100ml Ns","code_information":[{"code":"CP17744631829869419","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ferric Glu Inj 125mg/100ml Ns","code_information":[{"code":"CP17744631829863414","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ferric Gluc 100 Mg/100 Ml Ns","code_information":[{"code":"CP17744631829866302","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ferric Gluc Inj 125mg/100ml Ns","code_information":[{"code":"CP17744631829864259","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ferric Gluco Inj 12.5/ml","code_information":[{"code":"CP17744631829867736","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Ketorolac    Sol 0.5%","code_information":[{"code":"CP17744631830197087","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Sodium Ferric Gluc 12.5/ml","code_information":[{"code":"CP17744631831050530","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tegretol     Tab 200mg","code_information":[{"code":"CP17744631831101622","type":"CDM"},{"code":"250","type":"RC"},{"code":"78050","type":"CPT","modifier":"905"}],"standard_charges":[{"setting":"outpatient","modifier_code":["905"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tegretol 200mg Tabs","code_information":[{"code":"CP17744631831107348","type":"CDM"},{"code":"250","type":"RC"},{"code":"78050","type":"CPT","modifier":"905"}],"standard_charges":[{"setting":"outpatient","modifier_code":["905"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Testosterone Gel 10mg/act","code_information":[{"code":"CP17744631831116694","type":"CDM"},{"code":"250","type":"RC"},{"code":"60378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clindamycin  Gel Tretinoi","code_information":[{"code":"CP17744631829259368","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682030030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dronabinol   Cap 5mg","code_information":[{"code":"CP17744631829743456","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478076206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lubiprostone Cap 24mcg","code_information":[{"code":"CP17744631830385003","type":"CDM"},{"code":"250","type":"RC"},{"code":"48041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Olopatadine  Sol 0.2%","code_information":[{"code":"CP17744631830672080","type":"CDM"},{"code":"250","type":"RC"},{"code":"58602000739","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Oxiconazole  Cre Nitrate","code_information":[{"code":"CP17744631830704477","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672135902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pilocarpine  Sol 1% Op","code_information":[{"code":"CP17744631830777712","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238174508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ventolin Hfa Aer","code_information":[{"code":"CP17744631831266260","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ventolin Hfa Aer 200 Inh","code_information":[{"code":"CP17744631831268231","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Desitin      Pst 40%","code_information":[{"code":"CP17744631829564716","type":"CDM"},{"code":"250","type":"RC"},{"code":"69968006101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desitin/ A&d/gerilanta/lidocai","code_information":[{"code":"CP17744631829562879","type":"CDM"},{"code":"250","type":"RC"},{"code":"69968006101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac   Sol 2%","code_information":[{"code":"CP17744631829597250","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672136908","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830115872","type":"CDM"},{"code":"250","type":"RC"},{"code":"70795241202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ivermectin   Tab 3mg","code_information":[{"code":"CP17744631830174474","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799080601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Lubricating  Sol Tears","code_information":[{"code":"CP17744631830388789","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lubricating Tears0.1-0.3% 15ml","code_information":[{"code":"CP17744631830382860","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Morphine Sul Inj 4mg/ml","code_information":[{"code":"CP17744631830503434","type":"CDM"},{"code":"250","type":"RC"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Polyeth Glyc Pow 3350","code_information":[{"code":"CP17744631830787992","type":"CDM"},{"code":"250","type":"RC"},{"code":"69230032434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupren/nalox Mis 8-2mg","code_information":[{"code":"CP17744631828970352","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742036430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Olanzapine   Tab 10mg Odt","code_information":[{"code":"CP17744631830663540","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746030732","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxytrol For Women","code_information":[{"code":"CP17744631830724822","type":"CDM"},{"code":"250","type":"RC"},{"code":"23963","type":"CPT","modifier":"704"}],"standard_charges":[{"setting":"outpatient","modifier_code":["704"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxytrol/womn Dis 3.9mg/24","code_information":[{"code":"CP17744631830729357","type":"CDM"},{"code":"250","type":"RC"},{"code":"23963","type":"CPT","modifier":"704"}],"standard_charges":[{"setting":"outpatient","modifier_code":["704"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":39,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830774225","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Piper/tazo 3.375 Gm/50 Ml Ns","code_information":[{"code":"CP17744631830770561","type":"CDM"},{"code":"250","type":"RC"},{"code":"81284015210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375g/100ml Ns","code_information":[{"code":"CP17744631830771779","type":"CDM"},{"code":"250","type":"RC"},{"code":"61990012002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3gm/50 Ml Ns","code_information":[{"code":"CP17744631830779904","type":"CDM"},{"code":"250","type":"RC"},{"code":"81284015210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830786331","type":"CDM"},{"code":"250","type":"RC"},{"code":"61990012002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830782820","type":"CDM"},{"code":"250","type":"RC"},{"code":"81284015210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830785518","type":"CDM"},{"code":"250","type":"RC"},{"code":"61990012002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Ns","code_information":[{"code":"CP17744631830780057","type":"CDM"},{"code":"250","type":"RC"},{"code":"81284015210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piperac/tazo *Dont Use*","code_information":[{"code":"CP17744631830789230","type":"CDM"},{"code":"250","type":"RC"},{"code":"61990012002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Piperac/tazo 3.375g/50ml D5w","code_information":[{"code":"CP17744631830782558","type":"CDM"},{"code":"250","type":"RC"},{"code":"61990012002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Amp-sulbacta Inj 1.5gm","code_information":[{"code":"CP17744631828539259","type":"CDM"},{"code":"250","type":"RC"},{"code":"40926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Glutose 15   Gel 40%","code_information":[{"code":"CP17744631830041492","type":"CDM"},{"code":"250","type":"RC"},{"code":"57400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Glutose 15 40% Gel","code_information":[{"code":"CP17744631830041060","type":"CDM"},{"code":"250","type":"RC"},{"code":"57400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Glutose 15 Gel 40% 37.5gm","code_information":[{"code":"CP17744631830053747","type":"CDM"},{"code":"250","type":"RC"},{"code":"57400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Sitagliptin  Tab 100mg","code_information":[{"code":"CP17744631831026610","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710190109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sitagliptin  Tab 25mg","code_information":[{"code":"CP17744631831029974","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710189909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amlod/atorva Tab 5-10mg","code_information":[{"code":"CP17744631828480140","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993026630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/atorva Tab 5-20mg","code_information":[{"code":"CP17744631828480779","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993026730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlodipine-atorvastatin 5-10mg","code_information":[{"code":"CP17744631828492792","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993026630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bupren/nalox Mis 12-3mg","code_information":[{"code":"CP17744631828979779","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Lomotil      Tab 2.5mg","code_information":[{"code":"CP17744631830350007","type":"CDM"},{"code":"250","type":"RC"},{"code":"25006","type":"CPT","modifier":"131"}],"standard_charges":[{"setting":"outpatient","modifier_code":["131"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mct Pro-cal  Pak","code_information":[{"code":"CP17744631830408329","type":"CDM"},{"code":"250","type":"RC"},{"code":"50600050236","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Megestrol Ac Sus 40mg/ml","code_information":[{"code":"CP17744631830414421","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954089610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Bd Nestable  Mis 1.5qt","code_information":[{"code":"CP17744631828848664","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305487","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829991587","type":"CDM"},{"code":"250","type":"RC"},{"code":"73289006001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Paroxetine   Tab 40mg","code_information":[{"code":"CP17744631830735704","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pilocarpine  Sol 4% Op","code_information":[{"code":"CP17744631830771531","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478022612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Morphine Sul Tab 200mg Er","code_information":[{"code":"CP17744631830505034","type":"CDM"},{"code":"250","type":"RC"},{"code":"40683","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830666427","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208043410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine    Tab 10mg Odt","code_information":[{"code":"CP17744631830667728","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 10mg Odt","code_information":[{"code":"CP17744631830664446","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine Odt 10mg Tabs","code_information":[{"code":"CP17744631830674226","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vanco 25mg/ml Opth Vial","code_information":[{"code":"CP17744631831226680","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831235213","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 1g In 200 Ml Ns","code_information":[{"code":"CP17744631831245650","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin 250 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631831248661","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin 25mg/ml Opth Vial","code_information":[{"code":"CP17744631831240058","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vancomycin 300 Mg /100 Ml Ns","code_information":[{"code":"CP17744631831247667","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Vancomycin 400 Mg /100 Ml Ns","code_information":[{"code":"CP17744631831249549","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Vancomycin 400mg / Ns 100ml","code_information":[{"code":"CP17744631831243377","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Vancomycin 500 Mg In 100 Ml Ns","code_information":[{"code":"CP17744631831247793","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 500 Mg/100 Ml El-d","code_information":[{"code":"CP17744631831248170","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 500 Mg/100 Ml El-j","code_information":[{"code":"CP17744631831248740","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631831244539","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 500mg 100ml Mb","code_information":[{"code":"CP17744631831240689","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 500mg/100ml","code_information":[{"code":"CP17744631831241899","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436002082","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831267150","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710134903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Colchicine   Cap 0.6mg","code_information":[{"code":"CP17744631829405961","type":"CDM"},{"code":"250","type":"RC"},{"code":"25404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"D5w/nacl     Inj 0.45%","code_information":[{"code":"CP17744631829459510","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"D5w/nacl 0.45% 1000ml Bag","code_information":[{"code":"CP17744631829454492","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Durapore Cl  Tap 2\"x10yds","code_information":[{"code":"CP17744631829767397","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333053802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neurontin    Cap 100mg","code_information":[{"code":"CP17744631830556202","type":"CDM"},{"code":"250","type":"RC"},{"code":"71080","type":"CPT","modifier":"324"}],"standard_charges":[{"setting":"outpatient","modifier_code":["324"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabaln Er Tab 82.5mg","code_information":[{"code":"CP17744631830826395","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205007730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":825,"type":"ME"}},{"description":"Alendronate  Tab 35mg","code_information":[{"code":"CP17744631828401295","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714063201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Eye Patch    Mis","code_information":[{"code":"CP17744631829832049","type":"CDM"},{"code":"250","type":"RC"},{"code":"23185014505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticasone  Lot 0.05%","code_information":[{"code":"CP17744631829982095","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802044102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Vilazodone   Tab 20mg","code_information":[{"code":"CP17744631831273262","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205026130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830332473","type":"CDM"},{"code":"250","type":"RC"},{"code":"60318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Replesta     Waf 50000unt","code_information":[{"code":"CP17744631830890374","type":"CDM"},{"code":"250","type":"RC"},{"code":"2359046010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alendronate  Tab 35mg","code_information":[{"code":"CP17744631828409907","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543013004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Alendronate  Tab 35mg","code_information":[{"code":"CP17744631828407652","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097022316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Alendronate  Tab 35mg","code_information":[{"code":"CP17744631828401471","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714063202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Alendronate  Tab 70mg","code_information":[{"code":"CP17744631828406131","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543013104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Alendronate  Tab 70mg","code_information":[{"code":"CP17744631828406409","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980034214","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Alendronate  Tab 70mg","code_information":[{"code":"CP17744631828408890","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097022476","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Alendronate  Tab 70mg","code_information":[{"code":"CP17744631828407038","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097022416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Betameth Dip Oin 0.05%","code_information":[{"code":"CP17744631828875110","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Iodoform Str Mis 1/2\"x15'","code_information":[{"code":"CP17744631830157664","type":"CDM"},{"code":"250","type":"RC"},{"code":"84521006871","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alendronate  Tab 70mg","code_information":[{"code":"CP17744631828401029","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714063301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Alendronate  Tab 70mg","code_information":[{"code":"CP17744631828407573","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714063302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Alendronate 70mg Tabs","code_information":[{"code":"CP17744631828408125","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714063301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Fenofibrate  Tab 40mg","code_information":[{"code":"CP17744631829853573","type":"CDM"},{"code":"250","type":"RC"},{"code":"82619010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lamotrigine  Tab 250mg Er","code_information":[{"code":"CP17744631830211672","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111041930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Morphine Sul Tab 15mg","code_information":[{"code":"CP17744631830506286","type":"CDM"},{"code":"250","type":"RC"},{"code":"83202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Morphine Sulfate Ir 15 Mg Tabs","code_information":[{"code":"CP17744631830506232","type":"CDM"},{"code":"250","type":"RC"},{"code":"83202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Sevelamer    Pow 0.8gm","code_information":[{"code":"CP17744631831007231","type":"CDM"},{"code":"250","type":"RC"},{"code":"95510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831251144","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Acarbose     Tab 50mg","code_information":[{"code":"CP17744631828176693","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380075906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Alprazolam   Con 1 Mg/ml","code_information":[{"code":"CP17744631828448905","type":"CDM"},{"code":"250","type":"RC"},{"code":"54306","type":"CPT","modifier":"844"}],"standard_charges":[{"setting":"outpatient","modifier_code":["844"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"D5w/nacl     Inj 0.45%","code_information":[{"code":"CP17744631829455110","type":"CDM"},{"code":"250","type":"RC"},{"code":"26476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Insyte-n Autoguard 24gx0.56\"","code_information":[{"code":"CP17744631830151250","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Octreotide   Inj 100mcg","code_information":[{"code":"CP17744631830659490","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155068841","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sod Chloride Oin 5% Op","code_information":[{"code":"CP17744631831043785","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478062235","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Venlafaxine Er Tab 75mg","code_information":[{"code":"CP17744631831265088","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828502770","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862050320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Diltiazem    Cap 120mg Er","code_information":[{"code":"CP17744631829683894","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862033001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Diltiazem Er Tab 420mg","code_information":[{"code":"CP17744631829706961","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Morphine 10mg/ml Iv/im Soln","code_information":[{"code":"CP17744631830505395","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323045101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pentasa      Cap 250mg Cr","code_information":[{"code":"CP17744631830746539","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092018981","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Pill Cutter","code_information":[{"code":"CP17744631830778867","type":"CDM"},{"code":"250","type":"RC"},{"code":"2571567755","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clotrim/beta Cre Diprop","code_information":[{"code":"CP17744631829385364","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexlansopraz Cap 30mg Dr","code_information":[{"code":"CP17744631829571215","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979000106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Exemestane   Tab 25mg","code_information":[{"code":"CP17744631829835571","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991000590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Exemestane   Tab 25mg","code_information":[{"code":"CP17744631829830093","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651051630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Exemestane   Tab 25mg","code_information":[{"code":"CP17744631829835320","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781010830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Exemestane   Tab 25mg","code_information":[{"code":"CP17744631829832626","type":"CDM"},{"code":"250","type":"RC"},{"code":"71921019033","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Exemestane   Tab 25mg","code_information":[{"code":"CP17744631829830256","type":"CDM"},{"code":"250","type":"RC"},{"code":"54008","type":"CPT","modifier":"13"}],"standard_charges":[{"setting":"outpatient","modifier_code":["13"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Exemestane   Tab 25mg","code_information":[{"code":"CP17744631829834484","type":"CDM"},{"code":"250","type":"RC"},{"code":"83205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Protamine 10mg/ml Soln","code_information":[{"code":"CP17744631830854895","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Protamine Su Sol 10mg/ml","code_information":[{"code":"CP17744631830859836","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Scopolamine  Dis 1mg/3day","code_information":[{"code":"CP17744631830997930","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742050504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cholestyram  Pow 4gm Lite","code_information":[{"code":"CP17744631829229674","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806027095","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Diltiazem    Cap 60mg Er","code_information":[{"code":"CP17744631829697257","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862032801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lubiprostone Cap 24mcg","code_information":[{"code":"CP17744631830387698","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304035260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Clemastine   Tab 2.68mg","code_information":[{"code":"CP17744631829257112","type":"CDM"},{"code":"250","type":"RC"},{"code":"64950026810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":268,"type":"ME"}},{"description":"Iv Primary Tubing Duo-ven","code_information":[{"code":"CP17744631830173221","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lubiprostone Cap 24mcg","code_information":[{"code":"CP17744631830388894","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Nicotrol     Inh","code_information":[{"code":"CP17744631830564765","type":"CDM"},{"code":"250","type":"RC"},{"code":"95400","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pramoxine    Aer 1%","code_information":[{"code":"CP17744631830809594","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862018015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amphet/dextr Cap 25mg Er","code_information":[{"code":"CP17744631828518702","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993059802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"D5w/nacl     Inj 0.9%","code_information":[{"code":"CP17744631829454361","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"D5w/nacl Inj 0.9% 1000ml","code_information":[{"code":"CP17744631829455757","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Dilaudid     Inj 0.2mg/ml","code_information":[{"code":"CP17744631829600890","type":"CDM"},{"code":"250","type":"RC"},{"code":"76045012111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Elastomeric Pump200/100ml","code_information":[{"code":"CP17744631829763350","type":"CDM"},{"code":"250","type":"RC"},{"code":"62001000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ML"}},{"description":"Everolimus   Tab 0.5 Mg","code_information":[{"code":"CP17744631829838183","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991038006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Folic Acid   Inj 50/10ml","code_information":[{"code":"CP17744631829992304","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Ketoconazole Aer 2%","code_information":[{"code":"CP17744631830182185","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700016020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lidocaine 4ssd 1%","code_information":[{"code":"CP17744631830333760","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naftifine    Cre Hcl 2%","code_information":[{"code":"CP17744631830538584","type":"CDM"},{"code":"250","type":"RC"},{"code":"11515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Olanzapine   Tab 15mg","code_information":[{"code":"CP17744631830661574","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 7.5mg","code_information":[{"code":"CP17744631830661454","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603015601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Olanzapine 15mg Tabs","code_information":[{"code":"CP17744631830665599","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paricalcitol Cap 1 Mcg","code_information":[{"code":"CP17744631830738891","type":"CDM"},{"code":"250","type":"RC"},{"code":"69387010330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ssd          Cre 1%","code_information":[{"code":"CP17744631831068980","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ssd/vit A&d Cream","code_information":[{"code":"CP17744631831066112","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598021055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ca Alginate  Mis 4\"x4\"","code_information":[{"code":"CP17744631829051227","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080923300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Central Dressing Change","code_information":[{"code":"CP17744631829195673","type":"CDM"},{"code":"250","type":"RC"},{"code":"74661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Central Dressing Tray","code_information":[{"code":"CP17744631829199908","type":"CDM"},{"code":"250","type":"RC"},{"code":"74661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Introcan Iv Cath 18g","code_information":[{"code":"CP17744631830157309","type":"CDM"},{"code":"250","type":"RC"},{"code":"81009","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Introcan Safety 3 Iv Cath","code_information":[{"code":"CP17744631830156971","type":"CDM"},{"code":"250","type":"RC"},{"code":"4696401399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mirtazapine  Tab 45mg","code_information":[{"code":"CP17744631830497445","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505024908","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Mirtazapine 45mg Tabs","code_information":[{"code":"CP17744631830490814","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505024908","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Neutrogena   Bar Original","code_information":[{"code":"CP17744631830551248","type":"CDM"},{"code":"250","type":"RC"},{"code":"70501001010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sulfadiazine 500mg Tabs","code_information":[{"code":"CP17744631831073338","type":"CDM"},{"code":"250","type":"RC"},{"code":"18507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Thiothixene  Cap 10mg","code_information":[{"code":"CP17744631831129212","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219167601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aliskiren    Tab 150mg","code_information":[{"code":"CP17744631828402095","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993014130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Astagraf Xl  Cap 0.5mg","code_information":[{"code":"CP17744631828771137","type":"CDM"},{"code":"250","type":"RC"},{"code":"46906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829430218","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710166307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Paliperidone Tab Er 9mg","code_information":[{"code":"CP17744631830720960","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722032030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830782561","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567080210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830787997","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567080210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Prochlorper  Inj 10mg/2ml","code_information":[{"code":"CP17744631830830696","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457064099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prochlorperazine 5mg/50ml Ns","code_information":[{"code":"CP17744631830839894","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457064099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Thermacare Lbh 8hr","code_information":[{"code":"CP17744631831125959","type":"CDM"},{"code":"250","type":"RC"},{"code":"19588299001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/atorva Tab 10-40mg","code_information":[{"code":"CP17744631828487060","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598031530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amp 2gm/100ml Ns","code_information":[{"code":"CP17744631828518121","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin   Inj 2gm","code_information":[{"code":"CP17744631828524155","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin  2gm/ns100ml Mb+","code_information":[{"code":"CP17744631828529458","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 12gm/1000ml Ns","code_information":[{"code":"CP17744631828524358","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Ampicillin 1gm/50ml Ns","code_information":[{"code":"CP17744631828526791","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ampicillin 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828520790","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gm/100 Ml Ns Vm","code_information":[{"code":"CP17744631828523481","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gm/100ml Ns Mb","code_information":[{"code":"CP17744631828524731","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gm/100ml Ns Mb Kt","code_information":[{"code":"CP17744631828527895","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gram/100 Ml El-j","code_information":[{"code":"CP17744631828527604","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2gm/100ml Ns","code_information":[{"code":"CP17744631828523631","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin2gm/100ml","code_information":[{"code":"CP17744631828522543","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Carisoprodol Tab 250mg","code_information":[{"code":"CP17744631829132178","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571078001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Fluticasone  Aer 250mcg","code_information":[{"code":"CP17744631829984670","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993079297","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Glycopyrrol  Inj 0.2mg/ml","code_information":[{"code":"CP17744631830050503","type":"CDM"},{"code":"250","type":"RC"},{"code":"70121139405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nevirapine   Tab 400mg Er","code_information":[{"code":"CP17744631830552940","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342023807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830771822","type":"CDM"},{"code":"250","type":"RC"},{"code":"40933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Dispoz-a-bag Mis Med 19oz","code_information":[{"code":"CP17744631829714702","type":"CDM"},{"code":"250","type":"RC"},{"code":"8011150102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluphenazine 2.5mg Tabs","code_information":[{"code":"CP17744631829978544","type":"CDM"},{"code":"250","type":"RC"},{"code":"52717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levsin/sl    Sub 0.125mg","code_information":[{"code":"CP17744631830327209","type":"CDM"},{"code":"250","type":"RC"},{"code":"68220011310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830673500","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069000701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Allevyn Lite Pad 6\"x6\"","code_information":[{"code":"CP17744631828417517","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828505409","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714029702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Ketoconazole Aer 2%","code_information":[{"code":"CP17744631830182816","type":"CDM"},{"code":"250","type":"RC"},{"code":"37870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Thermacare   Pad Back S-m","code_information":[{"code":"CP17744631831126874","type":"CDM"},{"code":"250","type":"RC"},{"code":"95882099001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Mal 0.5% Ophth Soln","code_information":[{"code":"CP17744631831138087","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980051405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Vascepa      Cap 1gm","code_information":[{"code":"CP17744631831251146","type":"CDM"},{"code":"250","type":"RC"},{"code":"52937000120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vascepa 1gm Caps","code_information":[{"code":"CP17744631831252137","type":"CDM"},{"code":"250","type":"RC"},{"code":"52937000120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Elastic Band+clip 4\"x5yd","code_information":[{"code":"CP17744631829769952","type":"CDM"},{"code":"250","type":"RC"},{"code":"1093985644","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prednisolone Sus 1% Op","code_information":[{"code":"CP17744631830813666","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azithro 250mg/250ml Sod Cl 0.9","code_information":[{"code":"CP17744631828809163","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin 500mg Inj","code_information":[{"code":"CP17744631828816362","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Inj 500mg","code_information":[{"code":"CP17744631828816963","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Dextrose     Inj 5%","code_information":[{"code":"CP17744631829585723","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dextrose Inj 5% 1000ml","code_information":[{"code":"CP17744631829581348","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Filtered Transfer 0.2 Micron","code_information":[{"code":"CP17744631829950949","type":"CDM"},{"code":"250","type":"RC"},{"code":"41500","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Filtered Transfer Device","code_information":[{"code":"CP17744631829954723","type":"CDM"},{"code":"250","type":"RC"},{"code":"41500","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Infuvite 10ml In 1000ml D5w","code_information":[{"code":"CP17744631830145816","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Ivermectin   Cre 1%","code_information":[{"code":"CP17744631830170444","type":"CDM"},{"code":"250","type":"RC"},{"code":"57421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levothyroxin Cap 50mcg","code_information":[{"code":"CP17744631830313419","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347001504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830335623","type":"CDM"},{"code":"250","type":"RC"},{"code":"59135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 5% Patch","code_information":[{"code":"CP17744631830331959","type":"CDM"},{"code":"250","type":"RC"},{"code":"59135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Coban Wrap   Mis 3\"x5yds","code_information":[{"code":"CP17744631829392109","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131064119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Demeclocycl  Tab 300mg","code_information":[{"code":"CP17744631829551140","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162055548","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829990228","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332065560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Methotrexate 50mg/2ml Soln","code_information":[{"code":"CP17744631830442438","type":"CDM"},{"code":"250","type":"RC"},{"code":"61703035038","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Urost Pouch  Mis 1-3/4\"","code_information":[{"code":"CP17744631831211305","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380018402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Danazol      Cap 200mg","code_information":[{"code":"CP17744631829474881","type":"CDM"},{"code":"250","type":"RC"},{"code":"55506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Estradiol    Dis 0.05mg","code_information":[{"code":"CP17744631829813831","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tobramycin   Sol 0.3% Op","code_information":[{"code":"CP17744631831143401","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266019601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Cefpodoxime  Tab 100mg","code_information":[{"code":"CP17744631829176176","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862009520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lanthanum    Chw 750mg","code_information":[{"code":"CP17744631830216989","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180082046","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Lastacaft    Sol 0.25%","code_information":[{"code":"CP17744631830220163","type":"CDM"},{"code":"250","type":"RC"},{"code":"23429","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Closed Pouch Mis 2-1/2\"","code_information":[{"code":"CP17744631829381373","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380003325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxcarbazepin Tab 600mg","code_information":[{"code":"CP17744631830701460","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991029405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxymorphone  Tab 5mg Er","code_information":[{"code":"CP17744631830724686","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896069513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxymorphone Er 5mg Tab","code_information":[{"code":"CP17744631830729889","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896069513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Paricalcitol Inj 5mcg/ml","code_information":[{"code":"CP17744631830734486","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729031193","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Prevail Wmn  Mis Unwr Lg","code_information":[{"code":"CP17744631830824685","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891050119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sevelamer    Pow 0.8gm","code_information":[{"code":"CP17744631831002088","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452012619","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Carisoprodol Tab 250mg","code_information":[{"code":"CP17744631829129238","type":"CDM"},{"code":"250","type":"RC"},{"code":"51525590101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ceralyte 70  Pow","code_information":[{"code":"CP17744631829197285","type":"CDM"},{"code":"250","type":"RC"},{"code":"85100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexamethason Tab 1.5mg","code_information":[{"code":"CP17744631829577492","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954040110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Freshkote Pf Sol 2.7-2%","code_information":[{"code":"CP17744631830006985","type":"CDM"},{"code":"250","type":"RC"},{"code":"71776000110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":27,"type":"EA"}},{"description":"Methylphenid Cap 20mg Er","code_information":[{"code":"CP17744631830441682","type":"CDM"},{"code":"250","type":"RC"},{"code":"78123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nimodipine   Cap 30mg","code_information":[{"code":"CP17744631830561544","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155051230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Nimodipine   Cap 30mg","code_information":[{"code":"CP17744631830563619","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452020913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Olmesa Medox Tab 40mg","code_information":[{"code":"CP17744631830675721","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462043830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pred Sod Pho Sol 1% Op","code_information":[{"code":"CP17744631830819284","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208071510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zonisade     Sus 100mg/5","code_information":[{"code":"CP17744631831414206","type":"CDM"},{"code":"250","type":"RC"},{"code":"52652800101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Balsalazide  Cap 750mg","code_information":[{"code":"CP17744631828838886","type":"CDM"},{"code":"250","type":"RC"},{"code":"54007","type":"CPT","modifier":"928"}],"standard_charges":[{"setting":"outpatient","modifier_code":["928"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Lacosamide   Tab 200mg","code_information":[{"code":"CP17744631830202777","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722081560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Levetiraceta Tab 750mg","code_information":[{"code":"CP17744631830307538","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714053702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiracetam Tab 750mg","code_information":[{"code":"CP17744631830307502","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714053702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Methazolamid Tab 50mg","code_information":[{"code":"CP17744631830446633","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559024101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Morphine 2mg/ml Inj Vial","code_information":[{"code":"CP17744631830506869","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Morphine Sul Inj 4mg/ml","code_information":[{"code":"CP17744631830506667","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323045401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Paroxetine   Cap 7.5mg","code_information":[{"code":"CP17744631830730822","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547040903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830797552","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288012510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830792329","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288012530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobramycin   Sol 0.3% Op","code_information":[{"code":"CP17744631831141386","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314064305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Amp-sulbacta Inj 1.5gm","code_information":[{"code":"CP17744631828536743","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457034810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Cyclosporine Emu 0.05% Op","code_information":[{"code":"CP17744631829449134","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180021430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Isosorb Mono Tab 10mg","code_information":[{"code":"CP17744631830160767","type":"CDM"},{"code":"250","type":"RC"},{"code":"81665010210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lacosamide   Tab 150mg","code_information":[{"code":"CP17744631830203737","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991035006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lacosamide   Tab 150mg","code_information":[{"code":"CP17744631830204924","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722081460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lacosamide   Tab 200mg","code_information":[{"code":"CP17744631830204372","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714055201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ampicillin   Inj 2gm","code_information":[{"code":"CP17744631828523515","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin  2gm/ns100ml Mb+","code_information":[{"code":"CP17744631828524361","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin 2 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828521007","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567010310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829433574","type":"CDM"},{"code":"250","type":"RC"},{"code":"69680011210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin-1000mcg/ml- Inj","code_information":[{"code":"CP17744631829439893","type":"CDM"},{"code":"250","type":"RC"},{"code":"69680011210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dexamethason Tab 1.5mg","code_information":[{"code":"CP17744631829573924","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603018701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Nebivolol    Tab 2.5mg","code_information":[{"code":"CP17744631830548964","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756002530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Urine Leg Bag","code_information":[{"code":"CP17744631831214926","type":"CDM"},{"code":"250","type":"RC"},{"code":"91168","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Neb 0.5%","code_information":[{"code":"CP17744631828382744","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383074120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Budesonide   Cap 3mg Dr","code_information":[{"code":"CP17744631828951397","type":"CDM"},{"code":"250","type":"RC"},{"code":"37871","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Diflorasone  Oin 0.05%","code_information":[{"code":"CP17744631829601570","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980012460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Erythromycin Tab 500mg Ec","code_information":[{"code":"CP17744631829811580","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668058830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Iv Primary Tubing 2 Ports","code_information":[{"code":"CP17744631830178043","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanza/fluox 6-25mg Caps","code_information":[{"code":"CP17744631830669276","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884025011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Olanza/fluox Cap 6-25mg","code_information":[{"code":"CP17744631830661483","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884025011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Olanza/fluox Cap 6-50mg","code_information":[{"code":"CP17744631830661410","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884025111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Oxycodone    Tab 10mg Er","code_information":[{"code":"CP17744631830715480","type":"CDM"},{"code":"250","type":"RC"},{"code":"93573","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycodone Er 10mg Tabs","code_information":[{"code":"CP17744631830713007","type":"CDM"},{"code":"250","type":"RC"},{"code":"93573","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Demeclocycl  Tab 150mg","code_information":[{"code":"CP17744631829554400","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806014301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Demeclocycline 150mg Tabs","code_information":[{"code":"CP17744631829550558","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806014301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830786764","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594007902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Safty Needle Mis 20gx1\"","code_information":[{"code":"CP17744631830920424","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080850010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830104354","type":"CDM"},{"code":"250","type":"RC"},{"code":"57470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methylp Ss 1000 In 250ml Ns","code_information":[{"code":"CP17744631830443732","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Methylpr Ss  Inj 125mg","code_information":[{"code":"CP17744631830459052","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Methylprednisolone 125mg/100ml","code_information":[{"code":"CP17744631830456118","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Methylprednisolone 40mg/50ml","code_information":[{"code":"CP17744631830453815","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tramadol Hcl Tab 300mg Er","code_information":[{"code":"CP17744631831163323","type":"CDM"},{"code":"250","type":"RC"},{"code":"37841","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Trando/verap Tab 2-180 Er","code_information":[{"code":"CP17744631831167637","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462029501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Azithromycin Tab 600mg","code_information":[{"code":"CP17744631828817166","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224022230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Carvedilol   Cap 20mg Er","code_information":[{"code":"CP17744631829130597","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714022801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Dabigatran   Cap 150mg","code_information":[{"code":"CP17744631829461646","type":"CDM"},{"code":"250","type":"RC"},{"code":"72865027360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Doxepin      Tab 6mg","code_information":[{"code":"CP17744631829733229","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380020401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Metronidazol Inj 500mg","code_information":[{"code":"CP17744631830477310","type":"CDM"},{"code":"250","type":"RC"},{"code":"40901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metronidazole-500mg/100ml-sol","code_information":[{"code":"CP17744631830470538","type":"CDM"},{"code":"250","type":"RC"},{"code":"40901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nisoldipine  Tab 17mg Er","code_information":[{"code":"CP17744631830566200","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993047302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":17,"type":"ME"}},{"description":"Oxybutynin Td Patch 3.9 Mg/24h","code_information":[{"code":"CP17744631830717731","type":"CDM"},{"code":"250","type":"RC"},{"code":"23963","type":"CPT","modifier":"708"}],"standard_charges":[{"setting":"outpatient","modifier_code":["708"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":39,"type":"ME"}},{"description":"Oxytrol/womn Dis 3.9mg/24","code_information":[{"code":"CP17744631830729660","type":"CDM"},{"code":"250","type":"RC"},{"code":"23963","type":"CPT","modifier":"708"}],"standard_charges":[{"setting":"outpatient","modifier_code":["708"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":39,"type":"ME"}},{"description":"Pertzye      Cap 8000unit","code_information":[{"code":"CP17744631830757031","type":"CDM"},{"code":"250","type":"RC"},{"code":"59767000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8000,"type":"UN"}},{"description":"Prednisolone Sus 1% Op","code_information":[{"code":"CP17744631830819188","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748033202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trazodone    Tab 300mg","code_information":[{"code":"CP17744631831167219","type":"CDM"},{"code":"250","type":"RC"},{"code":"55507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Estrog/mtest Tab 1.25-2.5","code_information":[{"code":"CP17744631829829703","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559014901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Itraconazole Cap 100mg","code_information":[{"code":"CP17744631830163336","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714074302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pacerone     Tab 100mg","code_information":[{"code":"CP17744631830726018","type":"CDM"},{"code":"250","type":"RC"},{"code":"24501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pacerone     Tab 100mg","code_information":[{"code":"CP17744631830724505","type":"CDM"},{"code":"250","type":"RC"},{"code":"24501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Bicalutamide Tab 50mg","code_information":[{"code":"CP17744631828873658","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335048588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bicalutamide Tab 50mg","code_information":[{"code":"CP17744631828875606","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335048583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Colestipol   Gra 5gm","code_information":[{"code":"CP17744631829407398","type":"CDM"},{"code":"250","type":"RC"},{"code":"11552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Colestipol 5gm Pack","code_information":[{"code":"CP17744631829401688","type":"CDM"},{"code":"250","type":"RC"},{"code":"11552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Fenofibrate  Tab 40mg","code_information":[{"code":"CP17744631829854924","type":"CDM"},{"code":"250","type":"RC"},{"code":"11515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Natura+ Pouc Mis 1-3/4\"","code_information":[{"code":"CP17744631830543893","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455011335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Finger Splint+spt Md Apt","code_information":[{"code":"CP17744631829957676","type":"CDM"},{"code":"250","type":"RC"},{"code":"2571597483","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Filtered Ext Set 0.2mi","code_information":[{"code":"CP17744631830171999","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"422","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":3,"discounted_cash":3}]},{"description":"L-methylfola Cap Forte","code_information":[{"code":"CP17744631830359140","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830528817","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462056435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin 2% Cream","code_information":[{"code":"CP17744631830521458","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462056435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Qdolo        Sol 5mg/ml","code_information":[{"code":"CP17744631830853693","type":"CDM"},{"code":"250","type":"RC"},{"code":"71511030116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Huber Needle Set 22gx1\"","code_information":[{"code":"CP17744631830085635","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"030","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":3,"discounted_cash":3}]},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830105207","type":"CDM"},{"code":"250","type":"RC"},{"code":"70795241201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Isoniazid    Tab 300mg","code_information":[{"code":"CP17744631830164450","type":"CDM"},{"code":"250","type":"RC"},{"code":"81665010810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Linezolid    Tab 600mg","code_information":[{"code":"CP17744631830344655","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722074920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Linezolid    Tab 600mg","code_information":[{"code":"CP17744631830342192","type":"CDM"},{"code":"250","type":"RC"},{"code":"72606000107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"L-methyl-mc  Tab","code_information":[{"code":"CP17744631830354150","type":"CDM"},{"code":"250","type":"RC"},{"code":"76439036090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Multi-vite   Liq","code_information":[{"code":"CP17744631830521992","type":"CDM"},{"code":"250","type":"RC"},{"code":"69618000858","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Multi-vite Liquid","code_information":[{"code":"CP17744631830527598","type":"CDM"},{"code":"250","type":"RC"},{"code":"69618000858","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nimodipine   Cap 30mg","code_information":[{"code":"CP17744631830562946","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155051200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pip/taz 3.375g/100ml Mb+ Kt","code_information":[{"code":"CP17744631830778412","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Pip/tazo 3.375gm/100ml Elj","code_information":[{"code":"CP17744631830772127","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Pip/tazo 3.375gm/100ml El-j","code_information":[{"code":"CP17744631830772421","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Pip/tazo 3.375gm/100ml Ez","code_information":[{"code":"CP17744631830772431","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375 Gm/100 Ml Ns","code_information":[{"code":"CP17744631830774704","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375 Gm/50 Ml Ns","code_information":[{"code":"CP17744631830776959","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375g/100ml Ns","code_information":[{"code":"CP17744631830771927","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830777349","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830780115","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Ns","code_information":[{"code":"CP17744631830786703","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Alogliptin/  Tab Metform","code_information":[{"code":"CP17744631828438905","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802016972","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alogliptin/metformin Tabs","code_information":[{"code":"CP17744631828439694","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802016972","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azathioprine Tab 100mg","code_information":[{"code":"CP17744631828809910","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219203701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Bicalutamide Tab 50mg","code_information":[{"code":"CP17744631828878572","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bicalutamide Tab 50mg","code_information":[{"code":"CP17744631828878570","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729002301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Calcipotrien Oin Betameth","code_information":[{"code":"CP17744631829065272","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Everolimus   Tab 0.25mg","code_information":[{"code":"CP17744631829824606","type":"CDM"},{"code":"250","type":"RC"},{"code":"54047","type":"CPT","modifier":"21"}],"standard_charges":[{"setting":"outpatient","modifier_code":["21"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hc/aloe      Cre 0.5%","code_information":[{"code":"CP17744631830079381","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672201002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydrocort    Cre 0.5%","code_information":[{"code":"CP17744631830105415","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672201002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydrocortisone 0.5% Crm","code_information":[{"code":"CP17744631830110200","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672201002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ivabradine   Tab 5mg","code_information":[{"code":"CP17744631830174820","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722005360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Paroxetine   Tab 10mg","code_information":[{"code":"CP17744631830738588","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Terbutaline  Tab 2.5mg","code_information":[{"code":"CP17744631831114317","type":"CDM"},{"code":"250","type":"RC"},{"code":"11526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Triamcinolon Cre 0.1%","code_information":[{"code":"CP17744631831188172","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venlafaxine Er 150mg Tabs","code_information":[{"code":"CP17744631831262016","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Zin20/nys/tri0.1/lid3 2:1:1:1","code_information":[{"code":"CP17744631831397165","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bicalutamide Tab 50mg","code_information":[{"code":"CP17744631828870939","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ferrous Sulf Tab 325mg Ec","code_information":[{"code":"CP17744631829861016","type":"CDM"},{"code":"250","type":"RC"},{"code":"24501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Ferrous Sulfate Ec 325mg Tabs","code_information":[{"code":"CP17744631829868521","type":"CDM"},{"code":"250","type":"RC"},{"code":"24501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"L-methylfola Cap Forte 15","code_information":[{"code":"CP17744631830354596","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Mycophenolic Tab 180mg Dr","code_information":[{"code":"CP17744631830521500","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877042612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mycophenolic Tab 360mg Dr","code_information":[{"code":"CP17744631830521533","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877042712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Sevelam Carb Pow 0.8gm","code_information":[{"code":"CP17744631831007038","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380088080","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Sevelam Carb Pow 2.4gm","code_information":[{"code":"CP17744631831006401","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380088180","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Sevelamer    Pow 0.8gm","code_information":[{"code":"CP17744631831004264","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Sevelamer    Pow 2.4gm","code_information":[{"code":"CP17744631831004611","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Sevelamer    Pow 2.4gm","code_information":[{"code":"CP17744631831001994","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380088180","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Sevelamer 2.4gm Packets","code_information":[{"code":"CP17744631831010030","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Sevelamer Carb Pack 0.8gm","code_information":[{"code":"CP17744631831015797","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Sevelamer Carb Pack 2.4gm","code_information":[{"code":"CP17744631831010707","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Sevelamer Carbonate-0.8gm-pack","code_information":[{"code":"CP17744631831017928","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"GR"}},{"description":"Ace Elast Bandage 2in","code_information":[{"code":"CP17744631828185349","type":"CDM"},{"code":"250","type":"RC"},{"code":"5113120812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acetylcyst   Sol 20%","code_information":[{"code":"CP17744631828300868","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Lamotrigine  Tab 50mg Er","code_information":[{"code":"CP17744631830213962","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111071830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Likmez       Sus 500/5ml","code_information":[{"code":"CP17744631830344591","type":"CDM"},{"code":"250","type":"RC"},{"code":"81033006620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Methylpr Ss  Inj 40mg","code_information":[{"code":"CP17744631830456267","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598012725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tobra/dexame Sus 0.3-0.1%","code_information":[{"code":"CP17744631831144374","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Drain Pouch  Mis 2-1/4\"","code_information":[{"code":"CP17744631829747404","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380018183","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Letrozole    Tab 2.5mg","code_information":[{"code":"CP17744631830294267","type":"CDM"},{"code":"250","type":"RC"},{"code":"93762","type":"CPT","modifier":"56"}],"standard_charges":[{"setting":"outpatient","modifier_code":["56"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Letrozole    Tab 2.5mg","code_information":[{"code":"CP17744631830290669","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651018030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tegaderm Flm Mis 6\"x8\"","code_information":[{"code":"CP17744631831109654","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333162801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Topiramate   Tab 50mg","code_information":[{"code":"CP17744631831155026","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097012315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vanco 10mg/ml Opth Dropperette","code_information":[{"code":"CP17744631831222646","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vanco 25mg/ml Opth Dropperette","code_information":[{"code":"CP17744631831220506","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vanco 25mg/ml Opth Vial","code_information":[{"code":"CP17744631831232191","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vanco 50mg/ml Opth. Susp","code_information":[{"code":"CP17744631831234393","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancom Tobram Ns 0.9% 250ml Ir","code_information":[{"code":"CP17744631831239387","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831232759","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 25mg/ml Opth. Susp.","code_information":[{"code":"CP17744631831242254","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vancomycin 500 Mg/100 Ml Ns","code_information":[{"code":"CP17744631831244491","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin-heparin Lock Flush","code_information":[{"code":"CP17744631831241049","type":"CDM"},{"code":"250","type":"RC"},{"code":"40943","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Versapro     Cre","code_information":[{"code":"CP17744631831269228","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779252905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Aer Hfa","code_information":[{"code":"CP17744631828370955","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802008801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Sul Hfa-108mcg/act","code_information":[{"code":"CP17744631828391854","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802008801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":108,"type":"ME"}},{"description":"Amp-sulbacta Inj 1.5gm","code_information":[{"code":"CP17744631828536498","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485041610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Labetalol    Tab 100mg","code_information":[{"code":"CP17744631830194382","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377006013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Letrozole    Tab 2.5mg","code_information":[{"code":"CP17744631830298875","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729003410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830669026","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ofloxacin 0.3% Ophth Drops","code_information":[{"code":"CP17744631830665362","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Promethazine 25mg Supp","code_information":[{"code":"CP17744631830847726","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672529701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Promethazine Sup 25mg","code_information":[{"code":"CP17744631830844299","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672529701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Thiamine Hcl Inj 200/2ml","code_information":[{"code":"CP17744631831127351","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Amikacin     Inj 1gm/4ml","code_information":[{"code":"CP17744631828465760","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Dilaudid     Tab 2mg","code_information":[{"code":"CP17744631829606327","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858012201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829840907","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332019030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lacosamide   Tab 100mg","code_information":[{"code":"CP17744631830209703","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722081360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Naloxone     Inj 0.4mg/ml","code_information":[{"code":"CP17744631830533355","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Dexmethylphe Cap 5mg Er","code_information":[{"code":"CP17744631829571810","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010000401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diclofenac   Sol 0.1% Op","code_information":[{"code":"CP17744631829595761","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314001425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac 0.1% Opth Sol","code_information":[{"code":"CP17744631829599185","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314001425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Change Tray","code_information":[{"code":"CP17744631830179472","type":"CDM"},{"code":"250","type":"RC"},{"code":"10080196138","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Change Tray W Chlorascrub","code_information":[{"code":"CP17744631830171580","type":"CDM"},{"code":"250","type":"RC"},{"code":"10080196138","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacosamide   Tab 100mg","code_information":[{"code":"CP17744631830208780","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991034906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Silodosin    Cap 4mg","code_information":[{"code":"CP17744631831010134","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651009530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Voriconazole Tab 50mg","code_information":[{"code":"CP17744631831304324","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714019801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Capecitabine Tab 150mg","code_information":[{"code":"CP17744631829100918","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729007212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cetirizine   Chw 10mg","code_information":[{"code":"CP17744631829208652","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cetirizine   Chw 5mg","code_information":[{"code":"CP17744631829209674","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cetirizine 10mg Chew","code_information":[{"code":"CP17744631829204781","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromazine 200mg Tabs","code_information":[{"code":"CP17744631829221823","type":"CDM"},{"code":"250","type":"RC"},{"code":"78159","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Protriptylin Tab 10mg","code_information":[{"code":"CP17744631830850176","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806009730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830925832","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808015703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830922807","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228011805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amikacin     Inj 500/2ml","code_information":[{"code":"CP17744631828461507","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Amikacin     Inj 500/2ml","code_information":[{"code":"CP17744631828468792","type":"CDM"},{"code":"250","type":"RC"},{"code":"70390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Amikacin 375mg/1000ml Ns Irr.","code_information":[{"code":"CP17744631828468068","type":"CDM"},{"code":"250","type":"RC"},{"code":"70390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Amikacin 400mg/ Ns 0.9% 100ml","code_information":[{"code":"CP17744631828469978","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Amikacin 500mg In 100ml Ns","code_information":[{"code":"CP17744631828467471","type":"CDM"},{"code":"250","type":"RC"},{"code":"70390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Amikacin 500mg/100ml Ns","code_information":[{"code":"CP17744631828461515","type":"CDM"},{"code":"250","type":"RC"},{"code":"70390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Amikacin 500mg/2ml Soln","code_information":[{"code":"CP17744631828469807","type":"CDM"},{"code":"250","type":"RC"},{"code":"70390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Amikacin 900 Mg/100ml Ns","code_information":[{"code":"CP17744631828464271","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323081502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Diltiazem    Cap 360mg Cd","code_information":[{"code":"CP17744631829693944","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682052101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Eprontia     Sol 25mg/ml","code_information":[{"code":"CP17744631829790004","type":"CDM"},{"code":"250","type":"RC"},{"code":"52652900102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lacosamide   Tab 100mg","code_information":[{"code":"CP17744631830202067","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877073460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lacosamide   Tab 150mg","code_information":[{"code":"CP17744631830207385","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462068060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lacosamide   Tab 200mg","code_information":[{"code":"CP17744631830209764","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462068160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Oxycodone    Tab 5mg","code_information":[{"code":"CP17744631830715964","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084035401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pramipexole  Tab 0.375 Er","code_information":[{"code":"CP17744631830809585","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714091601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Sod Sulfacet Sol 10% Op","code_information":[{"code":"CP17744631831049871","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Sulfacet Sod Sol 10% Op","code_information":[{"code":"CP17744631831073596","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208067004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"T.e.d.       Mis Sm/long","code_information":[{"code":"CP17744631831094032","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080733900","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromocriptin Tab 2.5mg","code_information":[{"code":"CP17744631828958058","type":"CDM"},{"code":"250","type":"RC"},{"code":"57401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Iv Ext Set 7\"","code_information":[{"code":"CP17744631830176881","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitrofur Mac Cap 50mg","code_information":[{"code":"CP17744631830561401","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603018301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Paricalcitol Cap 2 Mcg","code_information":[{"code":"CP17744631830735037","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483068803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Promethazine Sup 12.5mg","code_information":[{"code":"CP17744631830846002","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802075830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Promethazine Sup 25mg","code_information":[{"code":"CP17744631830848731","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802075930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Allevyn Gent Pad 3\"x3\"","code_information":[{"code":"CP17744631828410639","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Baclofen     Sol 10mg/5ml","code_information":[{"code":"CP17744631828821189","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817062008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diltiazem    Cap 90mg Er","code_information":[{"code":"CP17744631829695115","type":"CDM"},{"code":"250","type":"RC"},{"code":"37860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Fluocinonide Cre 0.05%","code_information":[{"code":"CP17744631829970572","type":"CDM"},{"code":"250","type":"RC"},{"code":"93026","type":"CPT","modifier":"215"}],"standard_charges":[{"setting":"outpatient","modifier_code":["215"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydroco/apap Tab 7.5-325","code_information":[{"code":"CP17744631830109935","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Pramipexole  Tab 0.5mg","code_information":[{"code":"CP17744631830802679","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237018290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Temozolomide Cap 5mg","code_information":[{"code":"CP17744631831115657","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diltiazem    Cap 90mg Er","code_information":[{"code":"CP17744631829691961","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714055401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Doxycycl Hyc Tab 150mg Dr","code_information":[{"code":"CP17744631829741074","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155014301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829974260","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135072801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Isosorb Mono Tab 120mg Er","code_information":[{"code":"CP17744631830167244","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668010601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Varenicline  Tab 0.5mg","code_information":[{"code":"CP17744631831246853","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748012749","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cefuroxime   Inj 750mg","code_information":[{"code":"CP17744631829182583","type":"CDM"},{"code":"250","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Desonide     Oin 0.05%","code_information":[{"code":"CP17744631829566386","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672128101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexmethylphe Cap 10mg Er","code_information":[{"code":"CP17744631829571338","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884004901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lanthanum    Chw 500mg","code_information":[{"code":"CP17744631830215925","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097093498","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lopin/riton  Tab 200-50mg","code_information":[{"code":"CP17744631830367364","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722055612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Morphine Sul Inj 10mg/ml","code_information":[{"code":"CP17744631830500921","type":"CDM"},{"code":"250","type":"RC"},{"code":"40918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Quetiapine   Tab 200mg Er","code_information":[{"code":"CP17744631830869495","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228038260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Quetiapine   Tab 200mg Er","code_information":[{"code":"CP17744631830866030","type":"CDM"},{"code":"250","type":"RC"},{"code":"71093013702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Quetiapine   Tab 200mg Er","code_information":[{"code":"CP17744631830861506","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342013509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Quetiapine   Tab 200mg Er","code_information":[{"code":"CP17744631830868688","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729009512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Systane      Oin","code_information":[{"code":"CP17744631831099061","type":"CDM"},{"code":"250","type":"RC"},{"code":"65050","type":"CPT","modifier":"935"}],"standard_charges":[{"setting":"outpatient","modifier_code":["935"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tretinoin    Gel 0.05%","code_information":[{"code":"CP17744631831176755","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682080045","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Heparin Sod  Inj 5000/ml","code_information":[{"code":"CP17744631830079681","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Ivermectin   Cre 1%","code_information":[{"code":"CP17744631830172043","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578012008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketoconazole Aer 2%","code_information":[{"code":"CP17744631830181688","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802053233","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Nystatin     Cre 100000","code_information":[{"code":"CP17744631830641489","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Paroxetine   Tab 25mg Er","code_information":[{"code":"CP17744631830730977","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241003022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Saxagliptin  Tab 2.5mg","code_information":[{"code":"CP17744631830990240","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862082530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Saxagliptin  Tab 5mg","code_information":[{"code":"CP17744631830991610","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462072730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fenofibrate  Cap 50mg","code_information":[{"code":"CP17744631829856980","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559046090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fluphenazine Con 5mg/ml","code_information":[{"code":"CP17744631829971397","type":"CDM"},{"code":"250","type":"RC"},{"code":"12106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mefenam Acid Cap 250mg","code_information":[{"code":"CP17744631830412301","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180018506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Mefenam Acid Cap 250mg","code_information":[{"code":"CP17744631830411037","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571025830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Tioconazole  Oin 6.5% Vag","code_information":[{"code":"CP17744631831132808","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348050859","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Tioconazole  Oin 6.5% Vag","code_information":[{"code":"CP17744631831134594","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677122401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Advair Disku Aer 100/50","code_information":[{"code":"CP17744631828359361","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Advair Diskus 100/50mcg 60 Inh","code_information":[{"code":"CP17744631828358767","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Azelastine   Dro 0.05%","code_information":[{"code":"CP17744631828804525","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505057804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bactrim Ds   Tab 800-160","code_information":[{"code":"CP17744631828833402","type":"CDM"},{"code":"250","type":"RC"},{"code":"49708014601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":800,"type":"EA"}},{"description":"Clindamycin  Aer 1%","code_information":[{"code":"CP17744631829253422","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672419403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829379126","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714085001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Diltiazem Er Tab 180mg","code_information":[{"code":"CP17744631829708005","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Fleet Mineral Oil Enema","code_information":[{"code":"CP17744631829954211","type":"CDM"},{"code":"250","type":"RC"},{"code":"13203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fleet Oil    Ene","code_information":[{"code":"CP17744631829953073","type":"CDM"},{"code":"250","type":"RC"},{"code":"13203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Sod  Inj 10000/ml","code_information":[{"code":"CP17744631830072979","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288040402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Hydrocort    Cre 2.5%","code_information":[{"code":"CP17744631830107920","type":"CDM"},{"code":"250","type":"RC"},{"code":"47203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydrocortisone 2.5% Cream","code_information":[{"code":"CP17744631830112809","type":"CDM"},{"code":"250","type":"RC"},{"code":"47203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830331591","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347050505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pilocarpine  Sol 1% Op","code_information":[{"code":"CP17744631830777617","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcin Ace Inj 40mg/ml","code_information":[{"code":"CP17744631831178238","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457062102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Visbiome Hig Pak Potency","code_information":[{"code":"CP17744631831271281","type":"CDM"},{"code":"250","type":"RC"},{"code":"69355041202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Tab 4mg","code_information":[{"code":"CP17744631828389088","type":"CDM"},{"code":"250","type":"RC"},{"code":"53489017701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Azithromycin Inj 500mg","code_information":[{"code":"CP17744631828812829","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Doxepin      Tab 3mg","code_information":[{"code":"CP17744631829732655","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380020301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Drain Pouch  Mis 57mm","code_information":[{"code":"CP17744631829748424","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010651","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocortiso Lot 0.1%","code_information":[{"code":"CP17744631830112978","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180095102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830433122","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241018860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830434793","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Metformin Er (24hr) 500mg Tabs","code_information":[{"code":"CP17744631830449598","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Morphine Sul Tab 15mg","code_information":[{"code":"CP17744631830500796","type":"CDM"},{"code":"250","type":"RC"},{"code":"54023","type":"CPT","modifier":"525"}],"standard_charges":[{"setting":"outpatient","modifier_code":["525"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Morphine Sulfate 15mg Tabs","code_information":[{"code":"CP17744631830503987","type":"CDM"},{"code":"250","type":"RC"},{"code":"54023","type":"CPT","modifier":"525"}],"standard_charges":[{"setting":"outpatient","modifier_code":["525"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829437773","type":"CDM"},{"code":"250","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin 1000mcg/ml Soln","code_information":[{"code":"CP17744631829430207","type":"CDM"},{"code":"250","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin 1000mcg/ml-inj","code_information":[{"code":"CP17744631829436102","type":"CDM"},{"code":"250","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin-1000mcg/ml- Inj","code_information":[{"code":"CP17744631829437966","type":"CDM"},{"code":"250","type":"RC"},{"code":"14396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Linezolid    Sus 100/5ml","code_information":[{"code":"CP17744631830345949","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762130804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830664215","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485061310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rivastigmine Dis 13.3/24","code_information":[{"code":"CP17744631830908513","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710119807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Dro 0.05%","code_information":[{"code":"CP17744631828807324","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335093890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dicyclomine  Tab 20mg","code_information":[{"code":"CP17744631829601352","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452031132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Eclipse Ndle Mis 21gx1.5\"","code_information":[{"code":"CP17744631829767124","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305765","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Icosapent    Cap 1gm","code_information":[{"code":"CP17744631830131033","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687076421","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Me/naphos/mb Tab Hyo 1","code_information":[{"code":"CP17744631830408463","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657045401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metformin Er Tab 1000mg","code_information":[{"code":"CP17744631830443481","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979014604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Nicotine Td  Dis 14mg/24h","code_information":[{"code":"CP17744631830558137","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598044770","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Piper/tazo 3.375g/100ml Ns","code_information":[{"code":"CP17744631830770966","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830789953","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485040310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Rivastigmine Dis 9.5mg/24","code_information":[{"code":"CP17744631830904489","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710119707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Safety Needle 21g X 1","code_information":[{"code":"CP17744631830920349","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305765","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thiothixene 10mg Caps","code_information":[{"code":"CP17744631831122904","type":"CDM"},{"code":"250","type":"RC"},{"code":"37850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Albuterol    Aer Hfa","code_information":[{"code":"CP17744631828378259","type":"CDM"},{"code":"250","type":"RC"},{"code":"25410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Hfa 108mcg Inh","code_information":[{"code":"CP17744631828399176","type":"CDM"},{"code":"250","type":"RC"},{"code":"25410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":108,"type":"ME"}},{"description":"Digoxin      Inj 0.25/ml","code_information":[{"code":"CP17744631829609716","type":"CDM"},{"code":"250","type":"RC"},{"code":"78130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Ft Earwax    Sol Removal","code_information":[{"code":"CP17744631830001018","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677115401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort Ac Sup 30mg","code_information":[{"code":"CP17744631830118006","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494030212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lidocaine Pa Pad 4%","code_information":[{"code":"CP17744631830330346","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylpr Ss  Inj 40mg","code_information":[{"code":"CP17744631830450605","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323025503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830541087","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Petroleum    Gel Jelly","code_information":[{"code":"CP17744631830752922","type":"CDM"},{"code":"250","type":"RC"},{"code":"90457","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Petroleum Jelly","code_information":[{"code":"CP17744631830755561","type":"CDM"},{"code":"250","type":"RC"},{"code":"90457","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sirolimus    Tab 1mg","code_information":[{"code":"CP17744631831026580","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111065301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Vanicream    Bar","code_information":[{"code":"CP17744631831249074","type":"CDM"},{"code":"250","type":"RC"},{"code":"45334032039","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromocriptin Cap 5mg","code_information":[{"code":"CP17744631828952138","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382011006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Klonopin     Tab 0.5mg","code_information":[{"code":"CP17744631830194261","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269060510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Montelukast  Chw 4mg","code_information":[{"code":"CP17744631830506742","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722072790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830507651","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722072890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Naproxen Dr  Tab 500mg","code_information":[{"code":"CP17744631830547605","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817038110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Pantoprazole 4mg/ml Susp","code_information":[{"code":"CP17744631830739194","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799095230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Pantoprazole Pak 40mg","code_information":[{"code":"CP17744631830733730","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799095230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Benadryl/caladryl","code_information":[{"code":"CP17744631828854321","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348033736","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calamine 8% Lotion","code_information":[{"code":"CP17744631829058200","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348033736","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Calamine-pramoxine 8% 1% Lot","code_information":[{"code":"CP17744631829055184","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348033736","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Iv Insyte Cath 18gx1.16\"","code_information":[{"code":"CP17744631830171909","type":"CDM"},{"code":"250","type":"RC"},{"code":"18116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Tab 27mg Er","code_information":[{"code":"CP17744631830457168","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":27,"type":"ME"}},{"description":"Pataday      Sol 0.1%","code_information":[{"code":"CP17744631830748986","type":"CDM"},{"code":"250","type":"RC"},{"code":"65427","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Quetiapine   Tab 200mg Er","code_information":[{"code":"CP17744631830861023","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Sm Caldyphen Lot 1-8%","code_information":[{"code":"CP17744631831035181","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348033736","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Aer Hfa","code_information":[{"code":"CP17744631828371957","type":"CDM"},{"code":"250","type":"RC"},{"code":"76282067942","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aspercreme   Pad Lido 4%","code_information":[{"code":"CP17744631828769651","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167005842","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"But/apap/caf 50/325/40mg","code_information":[{"code":"CP17744631829012710","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367020301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"But/apap/caf Tab","code_information":[{"code":"CP17744631829044380","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367020301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Buta-acet-caff 50-325-40 Tabs","code_information":[{"code":"CP17744631829044822","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367020301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Imipram Pam  Cap 100mg","code_information":[{"code":"CP17744631830135814","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180031506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nortriptylin Cap 75mg","code_information":[{"code":"CP17744631830571355","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672400401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Nortriptylin Cap 75mg","code_information":[{"code":"CP17744631830574984","type":"CDM"},{"code":"250","type":"RC"},{"code":"93081","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pregabalin   Cap 50mg","code_information":[{"code":"CP17744631830827643","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin 50mg Caps","code_information":[{"code":"CP17744631830820267","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin-50mg-caps","code_information":[{"code":"CP17744631830822480","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Rivastigmine Dis 13.3/24","code_information":[{"code":"CP17744631830908053","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991089930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rivastigmine Dis 13.3/24","code_information":[{"code":"CP17744631830901226","type":"CDM"},{"code":"250","type":"RC"},{"code":"37890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rivastigmine Dis 4.6mg/24","code_information":[{"code":"CP17744631830902067","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162082534","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Rivastigmine Dis 4.6mg/24","code_information":[{"code":"CP17744631830901217","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710119607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Rivastigmine Dis 4.6mg/24","code_information":[{"code":"CP17744631830901796","type":"CDM"},{"code":"250","type":"RC"},{"code":"37890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Rivastigmine Dis 4.6mg/24","code_information":[{"code":"CP17744631830909524","type":"CDM"},{"code":"250","type":"RC"},{"code":"78173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Rivastigmine Dis 4.6mg/24","code_information":[{"code":"CP17744631830905617","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991089730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Rivastigmine Dis 9.5mg/24","code_information":[{"code":"CP17744631830902425","type":"CDM"},{"code":"250","type":"RC"},{"code":"37890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Rivastigmine Dis 9.5mg/24","code_information":[{"code":"CP17744631830908874","type":"CDM"},{"code":"250","type":"RC"},{"code":"78173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Diclofenac   Sol 2%","code_information":[{"code":"CP17744631829591610","type":"CDM"},{"code":"250","type":"RC"},{"code":"57401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Insyte Autog Mis 20gx1.16","code_information":[{"code":"CP17744631830151330","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacosamide   Tab 100mg","code_information":[{"code":"CP17744631830209636","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462067960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pramipexole  Tab 2.25 Er","code_information":[{"code":"CP17744631830803384","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714091901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"EA"}},{"description":"Soothe Night Oin Op","code_information":[{"code":"CP17744631831058855","type":"CDM"},{"code":"250","type":"RC"},{"code":"10119002239","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ampicillin  2gm/ns100ml Mb+","code_information":[{"code":"CP17744631828525279","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457035210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Chloroquine  Tab 250mg","code_information":[{"code":"CP17744631829214919","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980017750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830111422","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714011001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831105044","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877048430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Atomoxetine  Cap 100mg","code_information":[{"code":"CP17744631828772253","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Atomoxetine  Cap 100mg","code_information":[{"code":"CP17744631828779398","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980037903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Atomoxetine  Cap 100mg","code_information":[{"code":"CP17744631828775820","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111056430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Atomoxetine  Cap 100mg","code_information":[{"code":"CP17744631828774150","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505283603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Atomoxetine  Cap 80mg","code_information":[{"code":"CP17744631828780858","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111056330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Atomoxetine  Cap 80mg","code_information":[{"code":"CP17744631828788352","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722071930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Atomoxetine  Cap 80mg","code_information":[{"code":"CP17744631828788276","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505283503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Atomoxetine  Cap 80mg","code_information":[{"code":"CP17744631828787466","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Atomoxetine 100mg Caps","code_information":[{"code":"CP17744631828783704","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462027130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Calcipotrien Sol 0.005%","code_information":[{"code":"CP17744631829064846","type":"CDM"},{"code":"250","type":"RC"},{"code":"71303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cephalexin   Tab 500mg","code_information":[{"code":"CP17744631829194433","type":"CDM"},{"code":"250","type":"RC"},{"code":"93224","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cephalexin 500mg Tabs","code_information":[{"code":"CP17744631829192291","type":"CDM"},{"code":"250","type":"RC"},{"code":"93224","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829372062","type":"CDM"},{"code":"250","type":"RC"},{"code":"40688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dapsone      Tab 100mg","code_information":[{"code":"CP17744631829478360","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954013610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Tab 50mg Dr","code_information":[{"code":"CP17744631829740382","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547046212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dressing Change Trays","code_information":[{"code":"CP17744631829746220","type":"CDM"},{"code":"250","type":"RC"},{"code":"6124791825","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lanthanum    Chw 500mg","code_information":[{"code":"CP17744631830214824","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993042285","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lanthanum    Chw 750mg","code_information":[{"code":"CP17744631830229036","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993042385","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levothyroxin Cap 137mcg","code_information":[{"code":"CP17744631830317263","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347004504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Polyeth Glyc Pow 3350 Nf","code_information":[{"code":"CP17744631830781130","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559015710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pramipexole  Tab 0.375 Er","code_information":[{"code":"CP17744631830807774","type":"CDM"},{"code":"250","type":"RC"},{"code":"69680014530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Pramipexole  Tab 4.5mg Er","code_information":[{"code":"CP17744631830808781","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714092201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Rivastigmine Dis 13.3/24","code_information":[{"code":"CP17744631830905294","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714011702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sterile Clean Room Gown","code_information":[{"code":"CP17744631831060783","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"040","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":3,"discounted_cash":3}]},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831113799","type":"CDM"},{"code":"250","type":"RC"},{"code":"57408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Timolol Mal  Sol 0.25% Op","code_information":[{"code":"CP17744631831134358","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980051305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Triamcinolon Aer Spray","code_information":[{"code":"CP17744631831170690","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802004502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triazolam    Tab 0.25mg","code_information":[{"code":"CP17744631831186957","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710128901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Valganciclov Sol 50mg/ml","code_information":[{"code":"CP17744631831229362","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241015919","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":3,"gross_charge":3,"discounted_cash":3,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":3},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cetirizine   Tab 10mg","code_information":[{"code":"CP17744631829201529","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001043696","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clindamycin  Gel 1%","code_information":[{"code":"CP17744631829250464","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Drainable Pouch #401502","code_information":[{"code":"CP17744631829744981","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010323","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Octreotide   Inj 100mcg","code_information":[{"code":"CP17744631830653258","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Octreotide 200mcg / 100ml Ns","code_information":[{"code":"CP17744631830664486","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Rivastigmine Dis 4.6mg/24","code_information":[{"code":"CP17744631830906609","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714011502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":46,"type":"ME"}},{"description":"Triamcinolon Pst 0.1%","code_information":[{"code":"CP17744631831184052","type":"CDM"},{"code":"250","type":"RC"},{"code":"70752014017","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Digoxin      Inj 0.25/ml","code_information":[{"code":"CP17744631829609631","type":"CDM"},{"code":"250","type":"RC"},{"code":"64114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Digoxin 0.25mg/ml Soln","code_information":[{"code":"CP17744631829606258","type":"CDM"},{"code":"250","type":"RC"},{"code":"64114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Finasteride  Tab 1mg","code_information":[{"code":"CP17744631829950234","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877045590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Galzin       Cap 25mg","code_information":[{"code":"CP17744631830022024","type":"CDM"},{"code":"250","type":"RC"},{"code":"57844021552","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Iv 0.2 Micron Filter Ext.","code_information":[{"code":"CP17744631830170803","type":"CDM"},{"code":"250","type":"RC"},{"code":"8507890070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Piper/taz 2.25gm/50ml D5 Mb","code_information":[{"code":"CP17744631830773806","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/taz 2.25gm/50ml Ns","code_information":[{"code":"CP17744631830778737","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/taz 2.25gm/50ml Ns Mb","code_information":[{"code":"CP17744631830770778","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazbac2.25g/100ml Ns Mb","code_information":[{"code":"CP17744631830776941","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830778125","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Prasugrel    Tab 10mg","code_information":[{"code":"CP17744631830809697","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505464303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prasugrel    Tab 10mg","code_information":[{"code":"CP17744631830801185","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729027310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prasugrel    Tab 10mg","code_information":[{"code":"CP17744631830800641","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162000203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prasugrel    Tab 5mg","code_information":[{"code":"CP17744631830806784","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505464203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Prasugrel 10mg Tabs","code_information":[{"code":"CP17744631830805840","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505464303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cyclophosph  Cap 50mg","code_information":[{"code":"CP17744631829440510","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332061931","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Darifenacin Er 7.5 Mg Tabs","code_information":[{"code":"CP17744631829548326","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097043102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Dexmethylphe Cap 10mg Er","code_information":[{"code":"CP17744631829577859","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664062288","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Entacapone   Tab 200mg","code_information":[{"code":"CP17744631829792067","type":"CDM"},{"code":"250","type":"RC"},{"code":"78155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Piper/tazbac2.25g/100ml Ns Mb","code_information":[{"code":"CP17744631830771124","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567080110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830774854","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567080110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Prasugrel 10mg Tabs","code_information":[{"code":"CP17744631830804258","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877060530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Proctosol Hc Cre 2.5%","code_information":[{"code":"CP17744631830832904","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631040701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Diclegis     Tab 10-10mg","code_information":[{"code":"CP17744631829596808","type":"CDM"},{"code":"250","type":"RC"},{"code":"55494010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diltiazem    Tab 120mg Er","code_information":[{"code":"CP17744631829694699","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097099202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Leflunomide  Tab 10mg","code_information":[{"code":"CP17744631830296439","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651034830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Leflunomide  Tab 10mg","code_information":[{"code":"CP17744631830294378","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155004303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Leflunomide  Tab 20mg","code_information":[{"code":"CP17744631830291773","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155004403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Leflunomide  Tab 20mg","code_information":[{"code":"CP17744631830299358","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702027803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Leflunomide  Tab 20mg","code_information":[{"code":"CP17744631830296002","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710115803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Leflunomide  Tab 20mg","code_information":[{"code":"CP17744631830293271","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505250301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Leflunomide  Tab 20mg","code_information":[{"code":"CP17744631830291160","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748013006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Leflunomide  Tab 20mg","code_information":[{"code":"CP17744631830291748","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332006230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Methenam Man Tab 1000mg","code_information":[{"code":"CP17744631830443500","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799010601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Minerin      Cre","code_information":[{"code":"CP17744631830481367","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681015500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830523065","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238202905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Pip/tazo 2.25gm/100ml Ns El-j","code_information":[{"code":"CP17744631830772032","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/taz 2.25gm/50ml Ns","code_information":[{"code":"CP17744631830777806","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830775731","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Piper/tazobac 2.25gm/100ml Ns","code_information":[{"code":"CP17744631830781769","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Sharps Cont  Mis Home","code_information":[{"code":"CP17744631831011983","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290323487","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sharps Container 1.4 Quart","code_information":[{"code":"CP17744631831012825","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290323487","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sotalol Hcl  Tab 80mg","code_information":[{"code":"CP17744631831059837","type":"CDM"},{"code":"250","type":"RC"},{"code":"69584084110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Antacid Regular Strength","code_information":[{"code":"CP17744631828536984","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cal/ket/mup/tri","code_information":[{"code":"CP17744631829055683","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cetaphil/triam 0.1%/bacit Oint","code_information":[{"code":"CP17744631829205437","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cetaphil/triam 0.1%/mupir Oint","code_information":[{"code":"CP17744631829208957","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Geri-lanta   Sus","code_information":[{"code":"CP17744631830037140","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocortisone/mupirocin Oint","code_information":[{"code":"CP17744631830114501","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insyte Autog Mis 22gx1\"","code_information":[{"code":"CP17744631830152414","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381523","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insyte Autog Mis 22gx1\"","code_information":[{"code":"CP17744631830155365","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insyte Autog Mis 24gx3/4\"","code_information":[{"code":"CP17744631830152308","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Insyte Cath 22gx1","code_information":[{"code":"CP17744631830175058","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lansoprazole Tab 30mg Odt","code_information":[{"code":"CP17744631830211466","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598056178","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lido/myl/zinc/clot 1:1:1:1","code_information":[{"code":"CP17744631830329698","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido-diphen-mylanta 1-1-1","code_information":[{"code":"CP17744631830343576","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Milk Of Magn Sus 1200/15","code_information":[{"code":"CP17744631830488181","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348017138","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1200,"type":"EA"}},{"description":"Mupircin Oin / Lidocaine Gel","code_information":[{"code":"CP17744631830529047","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupircin Oin / Lidocaine Oin","code_information":[{"code":"CP17744631830525329","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830521723","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830526218","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin    Oin 2%","code_information":[{"code":"CP17744631830522740","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin 2% Betameth 0.05%","code_information":[{"code":"CP17744631830522938","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin 2%/lidocaine 5%","code_information":[{"code":"CP17744631830525730","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin Oint 2%hc Oint 1%","code_information":[{"code":"CP17744631830529453","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin Oint -Lido Crm 2%-3%","code_information":[{"code":"CP17744631830529059","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin/pimecrolimus/cetaphi","code_information":[{"code":"CP17744631830527635","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin/vaseline Gelointment","code_information":[{"code":"CP17744631830529509","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenobarbital 16.2mg Tabs","code_information":[{"code":"CP17744631830769072","type":"CDM"},{"code":"250","type":"RC"},{"code":"75826011810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":162,"type":"ME"}},{"description":"Phenohytro   Tab","code_information":[{"code":"CP17744631830762965","type":"CDM"},{"code":"250","type":"RC"},{"code":"75826011810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830786637","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860012130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Ns","code_information":[{"code":"CP17744631830789156","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860012130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piperac/tazo 3.375g/100ml D5w","code_information":[{"code":"CP17744631830789434","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860012130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Triam 0.1/bactro Cr/cetaphil","code_information":[{"code":"CP17744631831179887","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triam Crm/mupiro Oint/cetaphil","code_information":[{"code":"CP17744631831176607","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Divalproex   Tab 500mg Er","code_information":[{"code":"CP17744631829712764","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714048501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Divalproex Er 500mg Tabs","code_information":[{"code":"CP17744631829716591","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714048501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Insyte Autog Mis 20gx1\"","code_information":[{"code":"CP17744631830153908","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381433","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketorolac    Sol 0.5%","code_information":[{"code":"CP17744631830192312","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478020919","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Methylphenid Cap 20mg Er","code_information":[{"code":"CP17744631830445176","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010001301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Mometasone   Spr 50mcg","code_information":[{"code":"CP17744631830503640","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505083001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mometasone 50mcg Nasal Spray","code_information":[{"code":"CP17744631830506746","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505083001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Adapalene    Cre 0.1%","code_information":[{"code":"CP17744631828349782","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802045384","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/atorva Tab 5-20mg","code_information":[{"code":"CP17744631828481713","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598031930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Eletone      Cre","code_information":[{"code":"CP17744631829763531","type":"CDM"},{"code":"250","type":"RC"},{"code":"17803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxymorphone  Tab 5mg Er","code_information":[{"code":"CP17744631830727700","type":"CDM"},{"code":"250","type":"RC"},{"code":"64896069501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rivastigmine Dis 13.3/24","code_information":[{"code":"CP17744631830900719","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781040503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rivastigmine Dis 9.5mg/24","code_information":[{"code":"CP17744631830906618","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781030503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":95,"type":"ME"}},{"description":"Wound Packing Strip 1x5","code_information":[{"code":"CP17744631831385697","type":"CDM"},{"code":"250","type":"RC"},{"code":"47043","type":"CPT","modifier":"8"}],"standard_charges":[{"setting":"outpatient","modifier_code":["8"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amp-sulbacta Inj 1-0.5gm","code_information":[{"code":"CP17744631828536128","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567021010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Bd Insyte Autoguard Bc","code_information":[{"code":"CP17744631828840235","type":"CDM"},{"code":"250","type":"RC"},{"code":"77759","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluticasone  Aer 100mcg","code_information":[{"code":"CP17744631829986393","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993079197","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Kenalog-10   Inj 10mg/ml","code_information":[{"code":"CP17744631830185923","type":"CDM"},{"code":"250","type":"RC"},{"code":"30494","type":"CPT","modifier":"20"}],"standard_charges":[{"setting":"outpatient","modifier_code":["20"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lamivudine   Tab 100mg","code_information":[{"code":"CP17744631830217723","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722075260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lorazepam    Inj 4mg/ml","code_information":[{"code":"CP17744631830362765","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitro-bid    Oin 2%","code_information":[{"code":"CP17744631830568022","type":"CDM"},{"code":"250","type":"RC"},{"code":"28103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Pramipexole  Tab 0.375 Er","code_information":[{"code":"CP17744631830806703","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370025111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Pramipexole  Tab 0.75 Er","code_information":[{"code":"CP17744631830809888","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714091701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Pramipexole  Tab 1.5mg Er","code_information":[{"code":"CP17744631830802534","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714091801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pramipexole  Tab 3mg Er","code_information":[{"code":"CP17744631830809179","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714092001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Methylphenid Chw 2.5mg","code_information":[{"code":"CP17744631830453004","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980022101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Morphine Sul Cap 20mg Er","code_information":[{"code":"CP17744631830501099","type":"CDM"},{"code":"250","type":"RC"},{"code":"83202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Saline Mist  Spr 0.65%","code_information":[{"code":"CP17744631830935404","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802035758","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Saline Nasal Spr 0.65%","code_information":[{"code":"CP17744631830933560","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802035758","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Sod Chloride Oin 5% Op","code_information":[{"code":"CP17744631831047263","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ativan       Inj 2mg/ml","code_information":[{"code":"CP17744631828773847","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aveeno Moist Bar","code_information":[{"code":"CP17744631828801820","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137003623","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Combine      Pad 5\"x9\"","code_information":[{"code":"CP17744631829416690","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784035011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Erythrom Eth Sus 400/5ml","code_information":[{"code":"CP17744631829802369","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536013013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Hydromorphon Inj 2mg/ml","code_information":[{"code":"CP17744631830115223","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nisoldipine  Tab 8.5mg Er","code_information":[{"code":"CP17744631830567284","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993047202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":85,"type":"ME"}},{"description":"Olanzapine    Tab 15mg Odt","code_information":[{"code":"CP17744631830667290","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111026481","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 15mg Odt","code_information":[{"code":"CP17744631830665553","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111026481","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pullups Underwear 3x-l","code_information":[{"code":"CP17744631830859229","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vimpat       Sol 10mg/ml","code_information":[{"code":"CP17744631831275054","type":"CDM"},{"code":"250","type":"RC"},{"code":"13154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Albuterol    Tab 2mg","code_information":[{"code":"CP17744631828384853","type":"CDM"},{"code":"250","type":"RC"},{"code":"37802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ampicillin   Inj 2gm","code_information":[{"code":"CP17744631828521897","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594008702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ampicillin  2gm/ns100ml Mb+","code_information":[{"code":"CP17744631828528269","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594008702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Dexmethylphe Cap Er 25mg","code_information":[{"code":"CP17744631829577437","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714056601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lanthanum    Chw 750mg","code_information":[{"code":"CP17744631830210033","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097093598","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Lastacaft    Sol 0.25%","code_information":[{"code":"CP17744631830220626","type":"CDM"},{"code":"250","type":"RC"},{"code":"23429","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Neuriva Plus Cap","code_information":[{"code":"CP17744631830552949","type":"CDM"},{"code":"250","type":"RC"},{"code":"47865099551","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Np Thyroid   Tab 90mg","code_information":[{"code":"CP17744631830649289","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192033101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Pill Splittr Mis","code_information":[{"code":"CP17744631830778031","type":"CDM"},{"code":"250","type":"RC"},{"code":"49614012594","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830812066","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877046505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin-100mg-caps","code_information":[{"code":"CP17744631830823867","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877046505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Promethazine Sup 25mg","code_information":[{"code":"CP17744631830846826","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722004131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Quetiapine   Tab 150mg Er","code_information":[{"code":"CP17744631830862525","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729010912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Quetiapine   Tab 150mg Er","code_information":[{"code":"CP17744631830869858","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228038160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Quetiapine   Tab 150mg Er","code_information":[{"code":"CP17744631830868252","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180061307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Quetiapine   Tab 150mg Er","code_information":[{"code":"CP17744631830860291","type":"CDM"},{"code":"250","type":"RC"},{"code":"71093013602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Quetiapine   Tab 150mg Er","code_information":[{"code":"CP17744631830868962","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742063660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831252834","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714003802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Aaa Alkaline Battery","code_information":[{"code":"CP17744631828105113","type":"CDM"},{"code":"250","type":"RC"},{"code":"39800009909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clozapine    Tab 200mg","code_information":[{"code":"CP17744631829396048","type":"CDM"},{"code":"250","type":"RC"},{"code":"37809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ferralet 90  Tab","code_information":[{"code":"CP17744631829862673","type":"CDM"},{"code":"250","type":"RC"},{"code":"17800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":90,"type":"EA"}},{"description":"Fluvoxamine  Tab 100mg","code_information":[{"code":"CP17744631829988670","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505016601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluvoxamine 100mg Tabs","code_information":[{"code":"CP17744631829990341","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505016601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Matzim La    Tab 180mg/24","code_information":[{"code":"CP17744631830404283","type":"CDM"},{"code":"250","type":"RC"},{"code":"52544069130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mycophenolat Cap 250mg","code_information":[{"code":"CP17744631830528244","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380072607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Pantoprazole 40mg/100ml Ns","code_information":[{"code":"CP17744631830739269","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021075111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830788253","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288000331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830781615","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288000331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Roflumilast  Tab 500mcg","code_information":[{"code":"CP17744631830918733","type":"CDM"},{"code":"250","type":"RC"},{"code":"37819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831258213","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710135203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831259670","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980058103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831251076","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799096301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831256860","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834021990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831258236","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033004690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831254356","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710135209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Venlafaxine  Tab 225mg Er","code_information":[{"code":"CP17744631831254816","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834021930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Venlafaxine Er 225mg Tabs","code_information":[{"code":"CP17744631831266193","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033004630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"12hour Nasal Spr 0.05%","code_information":[{"code":"CP17744631828079575","type":"CDM"},{"code":"250","type":"RC"},{"code":"90467","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ft Earwax    Sol Removal","code_information":[{"code":"CP17744631830003362","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677115301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lansoprazole Tab 15mg Odt","code_information":[{"code":"CP17744631830211050","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lansoprazole Tab 15mg Odt","code_information":[{"code":"CP17744631830212529","type":"CDM"},{"code":"250","type":"RC"},{"code":"37869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lansoprazole Tab 15mg Odt","code_information":[{"code":"CP17744631830215217","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862089578","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lansoprazole Tab 30mg Odt","code_information":[{"code":"CP17744631830215501","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862089678","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 10mg Er","code_information":[{"code":"CP17744631830714470","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702080101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amox/clav 250-125mg Tabs","code_information":[{"code":"CP17744631828490741","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571016030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Amox/k Clav  Tab 250-125","code_information":[{"code":"CP17744631828504981","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571016030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Fluvastatin  Cap 40mg","code_information":[{"code":"CP17744631829980398","type":"CDM"},{"code":"250","type":"RC"},{"code":"93744","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Itraconazole Cap 100mg","code_information":[{"code":"CP17744631830176041","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729027110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitroglycern Sub 0.4mg","code_information":[{"code":"CP17744631830576523","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462063901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tetracyc/lid/m-dryl/ant/pred/w","code_information":[{"code":"CP17744631831120352","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tetracycline Cap 500mg","code_information":[{"code":"CP17744631831124033","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135026601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tetracycline Cap 500mg","code_information":[{"code":"CP17744631831121036","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155076701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tetracycline Cap 500mg","code_information":[{"code":"CP17744631831121491","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135026660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tetracycline Cap 500mg","code_information":[{"code":"CP17744631831123329","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238152301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tetracycline Cap 500mg","code_information":[{"code":"CP17744631831128605","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tetracycline Cap 500mg","code_information":[{"code":"CP17744631831125605","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155001801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Hydrocod/ibu Tab 5-200mg","code_information":[{"code":"CP17744631830107018","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746014601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metolazone   Tab 10mg","code_information":[{"code":"CP17744631830455275","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292056601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mometasone   Spr 50mcg","code_information":[{"code":"CP17744631830507482","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162089129","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mometasone 50mcg Nasal Spray","code_information":[{"code":"CP17744631830507470","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162089129","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxcarbazepin Tab 300mg","code_information":[{"code":"CP17744631830703807","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Oxcarbazepine 300mg Tabs","code_information":[{"code":"CP17744631830706400","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Oxcarbazepine Tab 300mg","code_information":[{"code":"CP17744631830701288","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Propranolol  Inj 1mg/ml","code_information":[{"code":"CP17744631830848603","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323060401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Stye         Oin","code_information":[{"code":"CP17744631831077499","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736014308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tranex Acid  Tab 650mg","code_information":[{"code":"CP17744631831168850","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918030130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Azithromycin 500mg Tabs","code_information":[{"code":"CP17744631828813806","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078867","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin 500mg Tabs","code_information":[{"code":"CP17744631828815780","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828819493","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224012230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828817686","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078867","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828817225","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828817143","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180086211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828813478","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862064230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828811637","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862064264","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828815830","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078855","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828816195","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828812864","type":"CDM"},{"code":"250","type":"RC"},{"code":"52723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828815220","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452017274","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Catheter Tray Change Kit","code_information":[{"code":"CP17744631829143768","type":"CDM"},{"code":"250","type":"RC"},{"code":"10012","type":"CPT","modifier":"8"}],"standard_charges":[{"setting":"outpatient","modifier_code":["8"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cetirizine   Chw 5mg","code_information":[{"code":"CP17744631829205490","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335034383","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Genteal Tear Oin Nt-time","code_information":[{"code":"CP17744631830031719","type":"CDM"},{"code":"250","type":"RC"},{"code":"65051","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking Anti Em Medium","code_information":[{"code":"CP17744631831069069","type":"CDM"},{"code":"250","type":"RC"},{"code":"11140","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stocking Anti Em X-large","code_information":[{"code":"CP17744631831061083","type":"CDM"},{"code":"250","type":"RC"},{"code":"11141","type":"CPT","modifier":"4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["4"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"T.e.d Stocking K-h Medium","code_information":[{"code":"CP17744631831094968","type":"CDM"},{"code":"250","type":"RC"},{"code":"11140","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"T.e.d Stocking K-h Small","code_information":[{"code":"CP17744631831093887","type":"CDM"},{"code":"250","type":"RC"},{"code":"11140","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"T.e.d Stocking K-h Xl","code_information":[{"code":"CP17744631831096762","type":"CDM"},{"code":"250","type":"RC"},{"code":"11141","type":"CPT","modifier":"4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["4"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobramycin   Sol 0.3% Op","code_information":[{"code":"CP17744631831149332","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Tobramycin 14mg/ml Ophth Sol","code_information":[{"code":"CP17744631831143016","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208029005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Azithromycin Tab 500mg","code_information":[{"code":"CP17744631828817343","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679096401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Bromocriptin Cap 5mg","code_information":[{"code":"CP17744631828955249","type":"CDM"},{"code":"250","type":"RC"},{"code":"37870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluocin Acet Oil Ear0.01%","code_information":[{"code":"CP17744631829969498","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925050820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamivu/zidovu 150-300mg Tabs","code_information":[{"code":"CP17744631830204296","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380070703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Levothyroxin Cap 100mcg","code_information":[{"code":"CP17744631830314734","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347003004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxin Cap 13mcg","code_information":[{"code":"CP17744631830317013","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347000504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":13,"type":"ME"}},{"description":"Methylphenid Cap 40mg Er","code_information":[{"code":"CP17744631830457001","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010001501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pot Iodide   Sol 1gm/ml","code_information":[{"code":"CP17744631830792526","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834028008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Roflumilast  Tab 250mcg","code_information":[{"code":"CP17744631830916953","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722067632","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Toe Spacer","code_information":[{"code":"CP17744631831145935","type":"CDM"},{"code":"250","type":"RC"},{"code":"8037601558","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831239097","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 250mg/5ml","code_information":[{"code":"CP17744631831244069","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin 500mg Inj Solr","code_information":[{"code":"CP17744631831244419","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860010410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Atomoxetine  Cap 40mg","code_information":[{"code":"CP17744631828785114","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722071730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Atomoxetine  Cap 40mg","code_information":[{"code":"CP17744631828782191","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505283303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Atomoxetine  Cap 40mg","code_information":[{"code":"CP17744631828785133","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111052130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Atomoxetine  Cap 40mg","code_information":[{"code":"CP17744631828788678","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714075801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Atomoxetine  Cap 60mg","code_information":[{"code":"CP17744631828786599","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722071830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Atomoxetine  Cap 60mg","code_information":[{"code":"CP17744631828789576","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505283403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Atomoxetine  Cap 60mg","code_information":[{"code":"CP17744631828782544","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980037703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Comfortfoam Border 4x4","code_information":[{"code":"CP17744631829414584","type":"CDM"},{"code":"250","type":"RC"},{"code":"83561","type":"CPT","modifier":"7"}],"standard_charges":[{"setting":"outpatient","modifier_code":["7"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829431582","type":"CDM"},{"code":"250","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin-1000mcg/ml- Inj","code_information":[{"code":"CP17744631829431823","type":"CDM"},{"code":"250","type":"RC"},{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Diltiazem    Cap 60mg Er","code_information":[{"code":"CP17744631829697646","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714055301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Fluticasone  Aer 50mcg","code_information":[{"code":"CP17744631829988409","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993079097","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluvastatin  Tab 80mg Er","code_information":[{"code":"CP17744631829986918","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Naproxen Dr  Tab 500mg","code_information":[{"code":"CP17744631830545787","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954092810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nicardipine  Cap 20mg","code_information":[{"code":"CP17744631830555422","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806050109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nicardipine  Cap 20mg","code_information":[{"code":"CP17744631830556658","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462012090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olmesa Medox Tab 5mg","code_information":[{"code":"CP17744631830672657","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877044530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olmesartan 5mg Tabs","code_information":[{"code":"CP17744631830674774","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877044530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830691188","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710101002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830699241","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205004411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830696400","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781047013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830699170","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722063231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830696878","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380079901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Spinosad     Sus 0.9%","code_information":[{"code":"CP17744631831053457","type":"CDM"},{"code":"250","type":"RC"},{"code":"28595057004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Stomach Relf Sus 525/30ml","code_information":[{"code":"CP17744631831078220","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Tizanidine   Cap 6mg","code_information":[{"code":"CP17744631831135084","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710111308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Albuterol    Tab 2mg","code_information":[{"code":"CP17744631828385945","type":"CDM"},{"code":"250","type":"RC"},{"code":"53489017601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Armour Thyro Tab 300mg","code_information":[{"code":"CP17744631828759194","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Estradiol    Cre 0.01%","code_information":[{"code":"CP17744631829818406","type":"CDM"},{"code":"250","type":"RC"},{"code":"93354","type":"CPT","modifier":"143"}],"standard_charges":[{"setting":"outpatient","modifier_code":["143"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol 0.1mg/gm Cream","code_information":[{"code":"CP17744631829825634","type":"CDM"},{"code":"250","type":"RC"},{"code":"93354","type":"CPT","modifier":"143"}],"standard_charges":[{"setting":"outpatient","modifier_code":["143"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Kapspargo    Cap 100mg","code_information":[{"code":"CP17744631830183322","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631001030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lactated Rin Inj","code_information":[{"code":"CP17744631830209623","type":"CDM"},{"code":"250","type":"RC"},{"code":"33801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Daptomycin 600mg/50ml Ns El-d","code_information":[{"code":"CP17744631829511036","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Daptomycin 625mg/50ml Ns El-d","code_information":[{"code":"CP17744631829529950","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Dexmethylphe Cap 10mg Er","code_information":[{"code":"CP17744631829576296","type":"CDM"},{"code":"250","type":"RC"},{"code":"11599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dronabinol   Cap 5mg","code_information":[{"code":"CP17744631829748291","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858086806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829989295","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598003701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Gas Relief   Dro 20/0.3ml","code_information":[{"code":"CP17744631830024850","type":"CDM"},{"code":"250","type":"RC"},{"code":"69618005951","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Levothyroxin Cap 112mcg","code_information":[{"code":"CP17744631830316967","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347003504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":112,"type":"ME"}},{"description":"Levothyroxin Cap 200mcg","code_information":[{"code":"CP17744631830316604","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347006004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Multidex Wound Filler Pow","code_information":[{"code":"CP17744631830526131","type":"CDM"},{"code":"250","type":"RC"},{"code":"46701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Natroba      Sus 0.9%","code_information":[{"code":"CP17744631830549094","type":"CDM"},{"code":"250","type":"RC"},{"code":"52246092904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Oxycodone    Tab 5mg","code_information":[{"code":"CP17744631830713534","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702001850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sod Chl 0.9% Iv Bag 1000ml","code_information":[{"code":"CP17744631831030065","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831044965","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sod Chloride Inj 0.9% 1000ml","code_information":[{"code":"CP17744631831045662","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Sodium Chlo-0.9% Iv Bag 1000ml","code_information":[{"code":"CP17744631831049513","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829986876","type":"CDM"},{"code":"250","type":"RC"},{"code":"52717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Memantine Er 14mg Caps","code_information":[{"code":"CP17744631830426298","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162078303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Er 21mg Caps","code_information":[{"code":"CP17744631830422090","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370034811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Er 21mg Caps","code_information":[{"code":"CP17744631830423650","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505621003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Er 28mg Caps","code_information":[{"code":"CP17744631830423013","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370034909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Er 28mg Caps","code_information":[{"code":"CP17744631830421327","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505621109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830421934","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436005506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830421716","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651040530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830422393","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651040590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830429083","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180024706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830420124","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382054716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830429858","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975026409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830429002","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382054706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830426311","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975026403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830429047","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505620909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 21mg Er","code_information":[{"code":"CP17744631830424754","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505621003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Hc Cap 21mg Er","code_information":[{"code":"CP17744631830427251","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436005604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Hc Cap 21mg Er","code_information":[{"code":"CP17744631830429192","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180024806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Hc Cap 21mg Er","code_information":[{"code":"CP17744631830420354","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975024303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Hc Cap 21mg Er","code_information":[{"code":"CP17744631830425522","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370034811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Hc Cap 21mg Er","code_information":[{"code":"CP17744631830428078","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651040630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Hc Cap 21mg Er","code_information":[{"code":"CP17744631830425031","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382054806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830425049","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436005706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830422876","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975026603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830427137","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505621109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830423735","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436005704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830423495","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370034909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830425545","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382054916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 28mg Er","code_information":[{"code":"CP17744631830422011","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975026609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":28,"type":"ME"}},{"description":"Memantine Hc Cap 7mg Er","code_information":[{"code":"CP17744631830425040","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436005404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Memantine Hc Cap 7mg Er","code_information":[{"code":"CP17744631830428498","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505620803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Memantine Hc Cap 7mg Er","code_information":[{"code":"CP17744631830429908","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382054606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Memantine Hc Cap 7mg Er","code_information":[{"code":"CP17744631830424272","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975024203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Memantine Hc Cap 7mg Er","code_information":[{"code":"CP17744631830425900","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180024606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Memantine Hc Cap 7mg Er","code_information":[{"code":"CP17744631830427697","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651040430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Morph In Nacl 200mg In 100ml","code_information":[{"code":"CP17744631830502228","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Morph In Nacl 400 Mg In 200ml","code_information":[{"code":"CP17744631830503024","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Morph/nacl 50mg/50ml","code_information":[{"code":"CP17744631830509803","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Morphine 10mg/ml Soln","code_information":[{"code":"CP17744631830509642","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olopatadine  Spr 0.6%","code_information":[{"code":"CP17744631830671951","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505084505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Calcipotrien Oin 0.005%","code_information":[{"code":"CP17744631829061552","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672415403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Levothyroxin Cap 150mcg","code_information":[{"code":"CP17744631830312342","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347005004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Primatene    Aer 0.125mg","code_information":[{"code":"CP17744631830839026","type":"CDM"},{"code":"250","type":"RC"},{"code":"17270055300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Primatene Mist-0.125mg/act","code_information":[{"code":"CP17744631830839574","type":"CDM"},{"code":"250","type":"RC"},{"code":"17270055300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Primatene Mist-0.125mg/act-aer","code_information":[{"code":"CP17744631830836528","type":"CDM"},{"code":"250","type":"RC"},{"code":"17270055300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Surgical Tapeclear","code_information":[{"code":"CP17744631831082254","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784035742","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zaditor      Dro 0.025%op","code_information":[{"code":"CP17744631831394196","type":"CDM"},{"code":"250","type":"RC"},{"code":"65401","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zaditor      Dro 0.035%op","code_information":[{"code":"CP17744631831397781","type":"CDM"},{"code":"250","type":"RC"},{"code":"65401","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828501175","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571016101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Budesonide   Sus 1mg/2ml","code_information":[{"code":"CP17744631828961140","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097032153","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Caffeine Cit Sol 60mg/3ml","code_information":[{"code":"CP17744631829053134","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754050103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dabigatran   Cap 150mg","code_information":[{"code":"CP17744631829467203","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505434806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Morphine Sul Cap 10mg Er","code_information":[{"code":"CP17744631830501039","type":"CDM"},{"code":"250","type":"RC"},{"code":"83202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Risperidone   Tab 4mg Odt","code_information":[{"code":"CP17744631830902776","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746005022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Risperidone  Tab 4mg Odt","code_information":[{"code":"CP17744631830908945","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746005022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Risperidone Odt 4mg Tabs","code_information":[{"code":"CP17744631830906154","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746005022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Alprazolam   Tab 0.5mg Xr","code_information":[{"code":"CP17744631828440351","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762005701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aminocaproic Sol 0.25/ml","code_information":[{"code":"CP17744631828465660","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817081508","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829212201","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205010591","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Heparin Sod  Inj 10000/ml","code_information":[{"code":"CP17744631830076456","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739096425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Juven        Pow","code_information":[{"code":"CP17744631830181888","type":"CDM"},{"code":"250","type":"RC"},{"code":"59781066695","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine Sul Tab 15mg Er","code_information":[{"code":"CP17744631830503743","type":"CDM"},{"code":"250","type":"RC"},{"code":"22842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Opium        Tin 10mg/ml","code_information":[{"code":"CP17744631830690831","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799021702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Roflumilast  Tab 500mcg","code_information":[{"code":"CP17744631830912690","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382096906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Roflumilast  Tab 500mcg","code_information":[{"code":"CP17744631830914425","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651027590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Roflumilast  Tab 500mcg","code_information":[{"code":"CP17744631830912992","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722062390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Roflumilast  Tab 500mcg","code_information":[{"code":"CP17744631830915122","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722062330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Roflumilast  Tab 500mcg","code_information":[{"code":"CP17744631830919288","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651027530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rufinamide   Tab 200mg","code_information":[{"code":"CP17744631830926272","type":"CDM"},{"code":"250","type":"RC"},{"code":"54042","type":"CPT","modifier":"523"}],"standard_charges":[{"setting":"outpatient","modifier_code":["523"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Thermacare   Mis Neck Pn","code_information":[{"code":"CP17744631831121933","type":"CDM"},{"code":"250","type":"RC"},{"code":"95882099006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromocriptin Cap 5mg","code_information":[{"code":"CP17744631828959760","type":"CDM"},{"code":"250","type":"RC"},{"code":"37870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829038557","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107007501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"But/apap/caff 50/325/40 Cap","code_information":[{"code":"CP17744631829045391","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107007501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Clozapine     Tab 100/odt","code_information":[{"code":"CP17744631829390432","type":"CDM"},{"code":"250","type":"RC"},{"code":"37838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Clozapine    Tab 100/odt","code_information":[{"code":"CP17744631829397344","type":"CDM"},{"code":"250","type":"RC"},{"code":"37838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Colace Clear Cap 50mg","code_information":[{"code":"CP17744631829405702","type":"CDM"},{"code":"250","type":"RC"},{"code":"67618011128","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"D-vite Pedia Dro 400unit","code_information":[{"code":"CP17744631829768495","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399740105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"UN"}},{"description":"Ext Tubing/  Mis Connect","code_information":[{"code":"CP17744631829831530","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380009346","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydromorphon Inj 1mg/ml","code_information":[{"code":"CP17744631830111425","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxin Cap 88mcg","code_information":[{"code":"CP17744631830312715","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347002504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"Lidocain/zinc Oxide/miconazole","code_information":[{"code":"CP17744631830324118","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269073556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Meclizine    Tab 50mg","code_information":[{"code":"CP17744631830400971","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571066201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Miconazlole 2%/ Mupirocin 2%","code_information":[{"code":"CP17744631830472653","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269073556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Miconazole   Cre 2%","code_information":[{"code":"CP17744631830471834","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269073556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Miconazole 2% / Zinc Oxide 20%","code_information":[{"code":"CP17744631830471188","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269073556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Miconazole/hc/zinc  Cream","code_information":[{"code":"CP17744631830487196","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269073556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nadolol      Tab 80mg","code_information":[{"code":"CP17744631830537324","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238112509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pimecrolimus Cre 1%","code_information":[{"code":"CP17744631830778064","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462060965","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ropinirole   Tab 2mg","code_information":[{"code":"CP17744631830917570","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462025601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tinidazole   Tab 500mg","code_information":[{"code":"CP17744631831133607","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799020801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Bd Insyte Autoguard Bc","code_information":[{"code":"CP17744631828846582","type":"CDM"},{"code":"250","type":"RC"},{"code":"77759","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefazolin    Inj 1gm","code_information":[{"code":"CP17744631829149049","type":"CDM"},{"code":"250","type":"RC"},{"code":"40925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cyclopentol  Sol 1% Op","code_information":[{"code":"CP17744631829441539","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Juven        Pow","code_information":[{"code":"CP17744631830180156","type":"CDM"},{"code":"250","type":"RC"},{"code":"59781066687","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 200mg Er","code_information":[{"code":"CP17744631830215812","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg Er","code_information":[{"code":"CP17744631830213627","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668034230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg Er","code_information":[{"code":"CP17744631830212318","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817024330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine Er 200mg Tab","code_information":[{"code":"CP17744631830215057","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Malathion    Lot 0.5%","code_information":[{"code":"CP17744631830395524","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672529404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829217105","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238106001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829217638","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710113201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829217827","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829216719","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829218243","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462086401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829211260","type":"CDM"},{"code":"250","type":"RC"},{"code":"52729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Chlorpromazine 100mg Tabs","code_information":[{"code":"CP17744631829221081","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238106001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Chlorpromazine 100mg Tabs","code_information":[{"code":"CP17744631829220685","type":"CDM"},{"code":"250","type":"RC"},{"code":"83203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Colestipol   Gra 5gm","code_information":[{"code":"CP17744631829407376","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762026001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Gent 528mg /Ster Water 1000ml","code_information":[{"code":"CP17744631830024568","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":528,"type":"ME"}},{"description":"Gent 80mg /Ster Water 1000ml","code_information":[{"code":"CP17744631830020284","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Irbesar/hctz Tab 150-12.5","code_information":[{"code":"CP17744631830162693","type":"CDM"},{"code":"250","type":"RC"},{"code":"93823","type":"CPT","modifier":"898"}],"standard_charges":[{"setting":"outpatient","modifier_code":["898"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Meclizine    Tab 12.5mg","code_information":[{"code":"CP17744631830409910","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084049001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Pilocarpine  Sol 1% Op","code_information":[{"code":"CP17744631830771914","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Risperidone  Tab 1mg Odt","code_information":[{"code":"CP17744631830902348","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884031591","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sod Chloride Inj 0.45 1000ml","code_information":[{"code":"CP17744631831040267","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Sod Chloride Inj 0.45%","code_information":[{"code":"CP17744631831046273","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"EA"}},{"description":"Steril Water Sol Irrig","code_information":[{"code":"CP17744631831064600","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/atorva Tab 2.5-10mg","code_information":[{"code":"CP17744631828482628","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993026330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829244624","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862007705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829726883","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547038209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Lopin/riton  Sol 80-20/ml","code_information":[{"code":"CP17744631830362661","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830879001","type":"CDM"},{"code":"250","type":"RC"},{"code":"59121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830870850","type":"CDM"},{"code":"250","type":"RC"},{"code":"59121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bisoprl/hctz Tab 2.5/6.25","code_information":[{"code":"CP17744631828932127","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799092001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Bisoprl/hctz Tab 5-6.25mg","code_information":[{"code":"CP17744631828937939","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799092101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sildenafil   Tab 100mg","code_information":[{"code":"CP17744631831016082","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291074830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Trimipramine Cap 25mg","code_information":[{"code":"CP17744631831192795","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991094401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Zenpep       Cap 5000unit","code_information":[{"code":"CP17744631831390882","type":"CDM"},{"code":"250","type":"RC"},{"code":"73562011501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Cepacol Cgh  Loz 5-7.5mg","code_information":[{"code":"CP17744631829198378","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824074416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cepacol Cgh Loz 5-7.5mg Berry","code_information":[{"code":"CP17744631829199436","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824074416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cepacol S/t & Cgh Loz 5-7.5mg","code_information":[{"code":"CP17744631829195240","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824074416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Creon        Cap 6000unit","code_information":[{"code":"CP17744631829438188","type":"CDM"},{"code":"250","type":"RC"},{"code":"32120","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6000,"type":"UN"}},{"description":"Creon Cap 6000unit","code_information":[{"code":"CP17744631829439355","type":"CDM"},{"code":"250","type":"RC"},{"code":"32120","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6000,"type":"UN"}},{"description":"Fluocin Acet Cre 0.01%","code_information":[{"code":"CP17744631829966326","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565003115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluphenazine Tab 1mg","code_information":[{"code":"CP17744631829982537","type":"CDM"},{"code":"250","type":"RC"},{"code":"52717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Olanzapine    Tab 10mg Odt","code_information":[{"code":"CP17744631830661406","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111026381","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 10mg Odt","code_information":[{"code":"CP17744631830668478","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111026381","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine Odt-10mg Tab","code_information":[{"code":"CP17744631830674806","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111026381","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Paliperidone Tab Er 1.5mg","code_information":[{"code":"CP17744631830722940","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180052306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paliperidone Tab Er 1.5mg","code_information":[{"code":"CP17744631830720017","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975034903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830729189","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975035003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830726439","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180052406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Paliperidone Tab Er 6mg","code_information":[{"code":"CP17744631830723514","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975035103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Paliperidone Tab Er 6mg","code_information":[{"code":"CP17744631830724219","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180052506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Solifenacin  Tab 10mg","code_information":[{"code":"CP17744631831057523","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831054851","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462038690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tacrolimus   Oin 0.03%","code_information":[{"code":"CP17744631831093392","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729042110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831238962","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457033950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetylcyst   Sol 10%","code_information":[{"code":"CP17744631828265885","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Bio-k Plus   Cap Strong","code_information":[{"code":"CP17744631828883990","type":"CDM"},{"code":"250","type":"RC"},{"code":"26608000150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chlorpromaz  Tab 100mg","code_information":[{"code":"CP17744631829213120","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Diclofenac   Sol 0.1% Op","code_information":[{"code":"CP17744631829592050","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478089210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac   Sol 0.1% Op","code_information":[{"code":"CP17744631829594661","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314001405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamivud/zido Tab 150-300","code_information":[{"code":"CP17744631830207789","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862003660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Neo/poly/dex Oin 0.1% Op","code_information":[{"code":"CP17744631830542571","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitrofurantn Sus 25mg/5ml","code_information":[{"code":"CP17744631830568311","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954049610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pip/tazo 2.25gm/100ml El-j","code_information":[{"code":"CP17744631830776265","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/taz 2.25gm/100ml Ns Mb","code_information":[{"code":"CP17744631830778448","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/taz 2.25gm/50ml Ns Mb","code_information":[{"code":"CP17744631830775645","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazbac2.25g/100ml Ns Mb","code_information":[{"code":"CP17744631830771461","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830773412","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830876061","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598074130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830873932","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598074101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Azulfidine   Tab 500mg En","code_information":[{"code":"CP17744631828811255","type":"CDM"},{"code":"250","type":"RC"},{"code":"13010","type":"CPT","modifier":"250"}],"standard_charges":[{"setting":"outpatient","modifier_code":["250"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azulfidine   Tab 500mg En","code_information":[{"code":"CP17744631828813226","type":"CDM"},{"code":"250","type":"RC"},{"code":"13010","type":"CPT","modifier":"260"}],"standard_charges":[{"setting":"outpatient","modifier_code":["260"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Butalb/aceta Tab 50-300mg","code_information":[{"code":"CP17744631829040392","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682030601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dapsone      Gel 5%","code_information":[{"code":"CP17744631829470325","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714095601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Drug Buster","code_information":[{"code":"CP17744631829752945","type":"CDM"},{"code":"250","type":"RC"},{"code":"88438919803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Drug Buster 64oz","code_information":[{"code":"CP17744631829757063","type":"CDM"},{"code":"250","type":"RC"},{"code":"88438919803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Infusion Subq 27x12 42","code_information":[{"code":"CP17744631830173455","type":"CDM"},{"code":"250","type":"RC"},{"code":"11404","type":"CPT","modifier":"15"}],"standard_charges":[{"setting":"outpatient","modifier_code":["15"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Konvomep     Sus 2-84/ml","code_information":[{"code":"CP17744631830196596","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628027203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Metronidazol Gel 0.75%","code_information":[{"code":"CP17744631830472254","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Mucus Rel Dm Tab 30-600er","code_information":[{"code":"CP17744631830517034","type":"CDM"},{"code":"250","type":"RC"},{"code":"53611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"EA"}},{"description":"Mucus Relief Dm 30-600mg Er Tb","code_information":[{"code":"CP17744631830515723","type":"CDM"},{"code":"250","type":"RC"},{"code":"53611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Mucus Relief Tab 30-600er","code_information":[{"code":"CP17744631830516870","type":"CDM"},{"code":"250","type":"RC"},{"code":"53611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"EA"}},{"description":"Nestabs      Tab","code_information":[{"code":"CP17744631830550360","type":"CDM"},{"code":"250","type":"RC"},{"code":"50967021990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenytek     Cap 300mg","code_information":[{"code":"CP17744631830762801","type":"CDM"},{"code":"250","type":"RC"},{"code":"37837","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Phenytek     Cap 300mg","code_information":[{"code":"CP17744631830768830","type":"CDM"},{"code":"250","type":"RC"},{"code":"37837","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Sm Tussin Dm Liq 5-100/5","code_information":[{"code":"CP17744631831038849","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677004801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Diltiazem Er Tab 360mg","code_information":[{"code":"CP17744631829703890","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Erythromycin Tab 333mg Ec","code_information":[{"code":"CP17744631829814011","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536018303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":333,"type":"ME"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829994114","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756060860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Fruitivitsâ® Orange","code_information":[{"code":"CP17744631830007680","type":"CDM"},{"code":"250","type":"RC"},{"code":"11601230000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 25mg Odt","code_information":[{"code":"CP17744631830212685","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine Odt 25mg Tabs","code_information":[{"code":"CP17744631830218977","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598055030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levothyroxin Cap 125mcg","code_information":[{"code":"CP17744631830316075","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347004004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Levothyroxin Cap 25mcg","code_information":[{"code":"CP17744631830315447","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347001004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levothyroxin Cap 75mcg","code_information":[{"code":"CP17744631830313427","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347002004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Levothyroxine  125mcg Caps","code_information":[{"code":"CP17744631830323993","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347004004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"L-methylfola Cap Forte","code_information":[{"code":"CP17744631830358546","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090833","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"L-methylfola Cap Forte 15","code_information":[{"code":"CP17744631830354573","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991090933","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Nicotine Td  Dis 7mg/24hr","code_information":[{"code":"CP17744631830564665","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598044674","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Temozolomide Cap 5mg","code_information":[{"code":"CP17744631831114165","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729004854","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Armour Thyro Tab 120mg","code_information":[{"code":"CP17744631828754106","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Cefadroxil   Cap 500mg","code_information":[{"code":"CP17744631829148144","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862008501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefadroxil   Cap 500mg","code_information":[{"code":"CP17744631829149202","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714038802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829434005","type":"CDM"},{"code":"250","type":"RC"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyanocobalamin-1000mcg/ml- Inj","code_information":[{"code":"CP17744631829435427","type":"CDM"},{"code":"250","type":"RC"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Depakote     Tab 125mg Dr","code_information":[{"code":"CP17744631829559968","type":"CDM"},{"code":"250","type":"RC"},{"code":"74732","type":"CPT","modifier":"513"}],"standard_charges":[{"setting":"outpatient","modifier_code":["513"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830101242","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367024312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydroxyz Hcl Tab 50mg","code_information":[{"code":"CP17744631830111714","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714008311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Phospho-trin Tab K500","code_information":[{"code":"CP17744631830768220","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328000810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Prednisolone Sol 20mg/5ml","code_information":[{"code":"CP17744631830816210","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799081301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831233001","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611076110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Zithromax    Tab Z-pak","code_information":[{"code":"CP17744631831404584","type":"CDM"},{"code":"250","type":"RC"},{"code":"69306","type":"CPT","modifier":"75"}],"standard_charges":[{"setting":"outpatient","modifier_code":["75"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828511206","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722019501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Cetirizine   Chw 10mg","code_information":[{"code":"CP17744631829207880","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335034483","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluconazole  Tab 200mg","code_information":[{"code":"CP17744631829969519","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fluconazole  Tab 200mg","code_information":[{"code":"CP17744631829962271","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710114003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fluconazole  Tab 200mg","code_information":[{"code":"CP17744631829969819","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559099330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830212169","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Testosterone Gel 1.62%","code_information":[{"code":"CP17744631831118823","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802028139","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ampicillin   Inj 1gm","code_information":[{"code":"CP17744631828527881","type":"CDM"},{"code":"250","type":"RC"},{"code":"40937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ciclopirox   Gel 0.77%","code_information":[{"code":"CP17744631829223238","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462045547","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Folbic Rf    Tab","code_information":[{"code":"CP17744631829994431","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991061690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Folbic Rf 1.13-25-2mg Tabs","code_information":[{"code":"CP17744631829999845","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991061690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":113,"type":"ME"}},{"description":"Metronidazol Pow Benzoate","code_information":[{"code":"CP17744631830476121","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779023804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine Sul Inj 4mg/ml","code_information":[{"code":"CP17744631830509464","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Olanzapine   Tab 5mg Odt","code_information":[{"code":"CP17744631830666805","type":"CDM"},{"code":"250","type":"RC"},{"code":"93524","type":"CPT","modifier":"565"}],"standard_charges":[{"setting":"outpatient","modifier_code":["565"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine   Tab 5mg Odt","code_information":[{"code":"CP17744631830661727","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884032055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine Odt 5mg Tabs","code_information":[{"code":"CP17744631830671495","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884032055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830875429","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714021301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Rufinamide   Tab 200mg","code_information":[{"code":"CP17744631830925046","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651061608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Rufinamide   Tab 200mg","code_information":[{"code":"CP17744631830929580","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462071308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Temozolomide Cap 5mg","code_information":[{"code":"CP17744631831114008","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162080151","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Temozolomide Cap 5mg","code_information":[{"code":"CP17744631831111451","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571081651","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Acampro Cal  Tab 333mg","code_information":[{"code":"CP17744631828155515","type":"CDM"},{"code":"250","type":"RC"},{"code":"37863","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":333,"type":"ME"}},{"description":"Amikacin     Inj 1gm/4ml","code_information":[{"code":"CP17744631828460205","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Amikacin 1gm In 100ml Ns","code_information":[{"code":"CP17744631828469910","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Amikacin 1gm/100ml Ns","code_information":[{"code":"CP17744631828468171","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Amikacin 400mg/ Ns 0.9% 100ml","code_information":[{"code":"CP17744631828464970","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Amikacin 750mg/100ml Ns","code_information":[{"code":"CP17744631828465475","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029042","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Atomoxetine  Cap 10mg","code_information":[{"code":"CP17744631828774140","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714075501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Atomoxetine  Cap 10mg","code_information":[{"code":"CP17744631828772143","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980037303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Atomoxetine  Cap 10mg","code_information":[{"code":"CP17744631828770588","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505283003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Atomoxetine  Cap 10mg","code_information":[{"code":"CP17744631828778645","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111051930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Atomoxetine  Cap 10mg","code_information":[{"code":"CP17744631828774929","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722071430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Atomoxetine  Cap 18mg","code_information":[{"code":"CP17744631828778205","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111052030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Atomoxetine  Cap 18mg","code_information":[{"code":"CP17744631828789174","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714075601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Atomoxetine  Cap 18mg","code_information":[{"code":"CP17744631828789022","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505283103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Atomoxetine  Cap 25mg","code_information":[{"code":"CP17744631828787101","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722071630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atomoxetine  Cap 25mg","code_information":[{"code":"CP17744631828782302","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111052830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atomoxetine  Cap 25mg","code_information":[{"code":"CP17744631828789237","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714075701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atomoxetine  Cap 25mg","code_information":[{"code":"CP17744631828785936","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505283203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atomoxetine  Cap 25mg","code_information":[{"code":"CP17744631828782776","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980037503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Calcitriol   Sol 1mcg/ml","code_information":[{"code":"CP17744631829066189","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304024159","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cefixime     Sus 200/5ml","code_information":[{"code":"CP17744631829177359","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Diltiazem    Cap 60mg Er","code_information":[{"code":"CP17744631829691431","type":"CDM"},{"code":"250","type":"RC"},{"code":"37860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Juven        Pow Frt Pnch","code_information":[{"code":"CP17744631830187196","type":"CDM"},{"code":"250","type":"RC"},{"code":"59781066684","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Juven        Pow Frt Pnch","code_information":[{"code":"CP17744631830183155","type":"CDM"},{"code":"250","type":"RC"},{"code":"59781066694","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830309209","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830303701","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Monsels Ferr Sol Subsulf","code_information":[{"code":"CP17744631830506226","type":"CDM"},{"code":"250","type":"RC"},{"code":"10481011208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830692738","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205004211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830690703","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722063031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830693101","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238126401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830694703","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710100802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830692961","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830693562","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 45mg","code_information":[{"code":"CP17744631830695248","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Oseltamivir  Cap 45mg","code_information":[{"code":"CP17744631830691664","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722063131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Oseltamivir  Cap 45mg","code_information":[{"code":"CP17744631830698163","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205004311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Oseltamivir  Cap 45mg","code_information":[{"code":"CP17744631830697411","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342025766","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Oseltamivir 30mg Caps","code_information":[{"code":"CP17744631830693395","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180067511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pilocarpine  Sol 1% Op","code_information":[{"code":"CP17744631830776188","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478022312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pilocarpine  Sol 2% Op","code_information":[{"code":"CP17744631830777048","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478022412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Darifenacin  Tab 15mg","code_information":[{"code":"CP17744631829543711","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097043202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Diclo/misopr Tab 50-0.2mg","code_information":[{"code":"CP17744631829593306","type":"CDM"},{"code":"250","type":"RC"},{"code":"59103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Diclo/misopr Tab 75-0.2mg","code_information":[{"code":"CP17744631829597061","type":"CDM"},{"code":"250","type":"RC"},{"code":"59103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Drainable Pouch 18103","code_information":[{"code":"CP17744631829743067","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380018103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv 1.2 Micron Filter Ext.","code_information":[{"code":"CP17744631830175793","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999402001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Memantine    Tab Hcl 10mg","code_information":[{"code":"CP17744631830417730","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300017205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Memantine 10mg Tabs","code_information":[{"code":"CP17744631830428869","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300017205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nifedipine   Cap 10mg","code_information":[{"code":"CP17744631830568252","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155019401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine    Tab 5mg Odt","code_information":[{"code":"CP17744631830661766","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine   Tab 5mg Odt","code_information":[{"code":"CP17744631830665781","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine Odt 5mg Tabs","code_information":[{"code":"CP17744631830673836","type":"CDM"},{"code":"250","type":"RC"},{"code":"37855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rimantadine  Tab 100mg","code_information":[{"code":"CP17744631830893763","type":"CDM"},{"code":"250","type":"RC"},{"code":"11519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Temozolomide Cap 5mg","code_information":[{"code":"CP17744631831113086","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877053714","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tretinoin    Gel 0.01%","code_information":[{"code":"CP17744631831177266","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tretinoin    Gel 0.025%","code_information":[{"code":"CP17744631831174395","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Famotidine   Tab 40mg","code_information":[{"code":"CP17744631829848448","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722001810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Genteal Tear Oin Nt-time","code_information":[{"code":"CP17744631830035875","type":"CDM"},{"code":"250","type":"RC"},{"code":"78047","type":"CPT","modifier":"397"}],"standard_charges":[{"setting":"outpatient","modifier_code":["397"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830300276","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385095505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830669659","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756060730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830668302","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603019201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Piper/taz 2.25gm/50ml Ns","code_information":[{"code":"CP17744631830777473","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594007802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":225,"type":"GR"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830776760","type":"CDM"},{"code":"250","type":"RC"},{"code":"70594007802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831136564","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478028810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Vitamin E Crm","code_information":[{"code":"CP17744631831300228","type":"CDM"},{"code":"250","type":"RC"},{"code":"7166102974","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azithromycin 500mg/250ml Ns","code_information":[{"code":"CP17744631828811761","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Inj 500mg","code_information":[{"code":"CP17744631828816753","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Benazep/hctz Tab 20-25mg","code_information":[{"code":"CP17744631828859155","type":"CDM"},{"code":"250","type":"RC"},{"code":"57402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Clotrim/beta Lot Diprop","code_information":[{"code":"CP17744631829385079","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fixodent+scope Adhsv Seal","code_information":[{"code":"CP17744631829951902","type":"CDM"},{"code":"250","type":"RC"},{"code":"7666030051","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluconazole  Tab 150mg","code_information":[{"code":"CP17744631829962120","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462011944","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Hydro 1% Silver 1%  Lidoc 4%","code_information":[{"code":"CP17744631830090944","type":"CDM"},{"code":"250","type":"RC"},{"code":"47203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort    Cre 1%","code_information":[{"code":"CP17744631830100134","type":"CDM"},{"code":"250","type":"RC"},{"code":"47203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort    Cre 1%","code_information":[{"code":"CP17744631830109479","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrogel Sheet Dressing","code_information":[{"code":"CP17744631830119419","type":"CDM"},{"code":"250","type":"RC"},{"code":"20612479141","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Insyte Autog 24gx0.75","code_information":[{"code":"CP17744631830170394","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Insyte Autog Mis 24gx3","code_information":[{"code":"CP17744631830175605","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 100mg Er","code_information":[{"code":"CP17744631830218598","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668034130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamotrigine  Tab 100mg Er","code_information":[{"code":"CP17744631830212088","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levothyroxin Cap 175mcg","code_information":[{"code":"CP17744631830314890","type":"CDM"},{"code":"250","type":"RC"},{"code":"82347005504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":175,"type":"ME"}},{"description":"Lidocain/mylanta/diphen/nystat","code_information":[{"code":"CP17744631830328934","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Sol 2% Visc","code_information":[{"code":"CP17744631830332846","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lidocaine 2% /Diphenhydram/ant","code_information":[{"code":"CP17744631830330684","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 2%/aller 12.5/ Gery","code_information":[{"code":"CP17744631830336565","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine And Antacid","code_information":[{"code":"CP17744631830333183","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine/benad/mylanta","code_information":[{"code":"CP17744631830339363","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine/maalox/diphen","code_information":[{"code":"CP17744631830343362","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido-diphen-mylanta 1-1-1","code_information":[{"code":"CP17744631830346889","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Magic Mouthwash","code_information":[{"code":"CP17744631830392641","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycodone    Tab 5mg","code_information":[{"code":"CP17744631830716778","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702001801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxycodone 5mg Tabs","code_information":[{"code":"CP17744631830715419","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702001801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pip/taz 3.375g/100ml Mb+ Kt","code_information":[{"code":"CP17744631830778360","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375 Gm / 100 D5w","code_information":[{"code":"CP17744631830779454","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375 Gm/100 Ml D5w","code_information":[{"code":"CP17744631830774796","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375 Gm/100 Ml Ns","code_information":[{"code":"CP17744631830773656","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazo 3.375 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830779067","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"ME"}},{"description":"Piper/tazo 3.375g/100ml Ns","code_information":[{"code":"CP17744631830775543","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830787671","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Piper/tazobac 3.375g/100ml Mb+","code_information":[{"code":"CP17744631830788946","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3375,"type":"GR"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830872524","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710134403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830878838","type":"CDM"},{"code":"250","type":"RC"},{"code":"83212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830875362","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817023530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830878022","type":"CDM"},{"code":"250","type":"RC"},{"code":"83212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830872390","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710134401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ramelteon    Tab 8mg","code_information":[{"code":"CP17744631830870842","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817023510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Silver Alginate Dressing","code_information":[{"code":"CP17744631831018973","type":"CDM"},{"code":"250","type":"RC"},{"code":"42311540681","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trianex      Oin 0.05%","code_information":[{"code":"CP17744631831188373","type":"CDM"},{"code":"250","type":"RC"},{"code":"67857080619","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ursodiol     Cap 300mg","code_information":[{"code":"CP17744631831218808","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829212161","type":"CDM"},{"code":"250","type":"RC"},{"code":"83203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluconazole  Tab 150mg","code_information":[{"code":"CP17744631829960416","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fluconazole  Tab 150mg","code_information":[{"code":"CP17744631829965028","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111014512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fluconazole 150mg Tabs","code_information":[{"code":"CP17744631829960768","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Hemorrhoidal Oin","code_information":[{"code":"CP17744631830072376","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Secondery Set","code_information":[{"code":"CP17744631830178357","type":"CDM"},{"code":"250","type":"RC"},{"code":"45797","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Cap 10mg","code_information":[{"code":"CP17744631830446019","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nitrofur Mac Cap 25mg","code_information":[{"code":"CP17744631830567490","type":"CDM"},{"code":"250","type":"RC"},{"code":"59136","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Secondary Medication Set","code_information":[{"code":"CP17744631830999661","type":"CDM"},{"code":"250","type":"RC"},{"code":"42221","type":"CPT","modifier":"61"}],"standard_charges":[{"setting":"outpatient","modifier_code":["61"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Benadryl/mupirocin Cream","code_information":[{"code":"CP17744631828859567","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diltiazem Er Tab 300mg","code_information":[{"code":"CP17744631829705005","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Mupiroc/hct/nyst/zinc Ox Cream","code_information":[{"code":"CP17744631830524375","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830527595","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830521618","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Mupirocin/cetaphil","code_information":[{"code":"CP17744631830525976","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mupirocin-lidocaine Oint 2%-2%","code_information":[{"code":"CP17744631830525963","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Oxycodone    Tab 20mg","code_information":[{"code":"CP17744631830713894","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858000401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pimecrolimus Cre 1%","code_information":[{"code":"CP17744631830770672","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682011102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Solifenacin  Tab 10mg","code_information":[{"code":"CP17744631831051465","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Solifenacin  Tab 10mg","code_information":[{"code":"CP17744631831051575","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505470303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Solifenacin  Tab 10mg","code_information":[{"code":"CP17744631831057657","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831056618","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300032819","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Triam 0.1/bactro Cr/cetaphil","code_information":[{"code":"CP17744631831178561","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triam Crm/mupiro Oint/cetaphil","code_information":[{"code":"CP17744631831173946","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zolpidem     Tab 10mg","code_information":[{"code":"CP17744631831401576","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Colchicine   Cap 0.6mg","code_information":[{"code":"CP17744631829407472","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651044601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Iv Admin Set / Flow Regul","code_information":[{"code":"CP17744631830172061","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"750","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":2,"discounted_cash":2}]},{"description":"Toprol Xl    Tab 100mg","code_information":[{"code":"CP17744631831152090","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842011202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ultrasite Valve","code_information":[{"code":"CP17744631831205421","type":"CDM"},{"code":"250","type":"RC"},{"code":"41511000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alprazolam   Tab 2mg","code_information":[{"code":"CP17744631828454370","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Depakote Spr 125mg Caps","code_information":[{"code":"CP17744631829552975","type":"CDM"},{"code":"250","type":"RC"},{"code":"74611","type":"CPT","modifier":"413"}],"standard_charges":[{"setting":"outpatient","modifier_code":["413"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Depakote Spr Cap 125mg","code_information":[{"code":"CP17744631829552040","type":"CDM"},{"code":"250","type":"RC"},{"code":"74611","type":"CPT","modifier":"413"}],"standard_charges":[{"setting":"outpatient","modifier_code":["413"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Foltanx Rf   Cap","code_information":[{"code":"CP17744631829990660","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991091333","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydromorphon Tab 4mg","code_information":[{"code":"CP17744631830112718","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858030201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Hydromorphone 4mg Tabs","code_information":[{"code":"CP17744631830116061","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858030201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Opium        Tin 10mg/ml","code_information":[{"code":"CP17744631830696556","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799021701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Alcon Tears  Dro 0.5%","code_information":[{"code":"CP17744631828407156","type":"CDM"},{"code":"250","type":"RC"},{"code":"65040","type":"CPT","modifier":"872"}],"standard_charges":[{"setting":"outpatient","modifier_code":["872"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alcon Tears Eye Drop","code_information":[{"code":"CP17744631828405837","type":"CDM"},{"code":"250","type":"RC"},{"code":"65040","type":"CPT","modifier":"872"}],"standard_charges":[{"setting":"outpatient","modifier_code":["872"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alcon Tears Eye Drops","code_information":[{"code":"CP17744631828409026","type":"CDM"},{"code":"250","type":"RC"},{"code":"30065040872","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cartia Xt    Cap 240/24hr","code_information":[{"code":"CP17744631829137290","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037059990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":240,"type":"EA"}},{"description":"Digoxin      Sol 50mcg/ml","code_information":[{"code":"CP17744631829603124","type":"CDM"},{"code":"250","type":"RC"},{"code":"54005","type":"CPT","modifier":"746"}],"standard_charges":[{"setting":"outpatient","modifier_code":["746"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Digoxin 0.05mg/ml Soln","code_information":[{"code":"CP17744631829603625","type":"CDM"},{"code":"250","type":"RC"},{"code":"54005","type":"CPT","modifier":"746"}],"standard_charges":[{"setting":"outpatient","modifier_code":["746"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fexofenadine Tab 180mg","code_information":[{"code":"CP17744631829948065","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Griseofulvin Tab Ultr 250","code_information":[{"code":"CP17744631830055613","type":"CDM"},{"code":"250","type":"RC"},{"code":"11517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Lanthanum    Chw 500mg","code_information":[{"code":"CP17744631830216819","type":"CDM"},{"code":"250","type":"RC"},{"code":"93593","type":"CPT","modifier":"898"}],"standard_charges":[{"setting":"outpatient","modifier_code":["898"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lanthanum    Chw 750mg","code_information":[{"code":"CP17744631830218799","type":"CDM"},{"code":"250","type":"RC"},{"code":"93593","type":"CPT","modifier":"998"}],"standard_charges":[{"setting":"outpatient","modifier_code":["998"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Ropinirole   Tab 12mg Er","code_information":[{"code":"CP17744631830916625","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111072830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Sotalol 120mg Tabs","code_information":[{"code":"CP17744631831055194","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505015900","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Sotalol Hcl  Tab 120mg","code_information":[{"code":"CP17744631831056320","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505015900","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Artifi Tears Oin Op","code_information":[{"code":"CP17744631828751860","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478006235","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Artificial Tears Ointment","code_information":[{"code":"CP17744631828753568","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478006235","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluconazole  Tab 150mg","code_information":[{"code":"CP17744631829967762","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fluconazole  Tab 200mg","code_information":[{"code":"CP17744631829962787","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710114001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fesoterodine Tab 4mg Er","code_information":[{"code":"CP17744631829862755","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862076630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fesoterodine Tab 4mg Er","code_information":[{"code":"CP17744631829860646","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877006430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fesoterodine Tab 8mg Er","code_information":[{"code":"CP17744631829865545","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862076730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Fesoterodine Tab 8mg Er","code_information":[{"code":"CP17744631829866234","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877006830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Halobetasol  Cre 0.05%","code_information":[{"code":"CP17744631830066026","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Mexiletine   Cap 250mg","code_information":[{"code":"CP17744631830475855","type":"CDM"},{"code":"250","type":"RC"},{"code":"93874","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Anastrozole  Tab 1mg","code_information":[{"code":"CP17744631828533582","type":"CDM"},{"code":"250","type":"RC"},{"code":"93753","type":"CPT","modifier":"656"}],"standard_charges":[{"setting":"outpatient","modifier_code":["656"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bupren/nalox Mis 2-0.5mg","code_information":[{"code":"CP17744631828977465","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598057930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"But/apap/caf 50-325-40mgtab","code_information":[{"code":"CP17744631829018322","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380015701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"But/apap/caf Tab","code_information":[{"code":"CP17744631829041121","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380015701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cal Alginate Dress  2\"x2\"","code_information":[{"code":"CP17744631829052499","type":"CDM"},{"code":"250","type":"RC"},{"code":"88326300000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcium Alg Dressing 2x2","code_information":[{"code":"CP17744631829077620","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcium Alginate Dressing","code_information":[{"code":"CP17744631829079350","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784030272","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dynaginate Calcium Alginate","code_information":[{"code":"CP17744631829763964","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784030272","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fesoterodine Tab 8mg Er","code_information":[{"code":"CP17744631829860765","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603041401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Icy Hot      Pad 4-1%","code_information":[{"code":"CP17744631830131426","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167017201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metolazone   Tab 10mg","code_information":[{"code":"CP17744631830458092","type":"CDM"},{"code":"250","type":"RC"},{"code":"18556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830777534","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860012020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Spinosad     Sus 0.9%","code_information":[{"code":"CP17744631831054468","type":"CDM"},{"code":"250","type":"RC"},{"code":"52246057004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Trileptal    Sus 300mg/5m","code_information":[{"code":"CP17744631831195978","type":"CDM"},{"code":"250","type":"RC"},{"code":"78035","type":"CPT","modifier":"752"}],"standard_charges":[{"setting":"outpatient","modifier_code":["752"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Trileptal 300mg/5ml","code_information":[{"code":"CP17744631831193921","type":"CDM"},{"code":"250","type":"RC"},{"code":"78035","type":"CPT","modifier":"752"}],"standard_charges":[{"setting":"outpatient","modifier_code":["752"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Albuterol    Aer Hfa","code_information":[{"code":"CP17744631828377461","type":"CDM"},{"code":"250","type":"RC"},{"code":"78172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol Hfa 90mcg 200 Inh","code_information":[{"code":"CP17744631828398468","type":"CDM"},{"code":"250","type":"RC"},{"code":"78172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"ME"}},{"description":"Anastrozole  Tab 1mg","code_information":[{"code":"CP17744631828533460","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651023630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Colestipol   Tab 1gm","code_information":[{"code":"CP17744631829405954","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762045001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Diltiazem    Cap 120mg Er","code_information":[{"code":"CP17744631829604794","type":"CDM"},{"code":"250","type":"RC"},{"code":"37861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Fesoterodine Tab 4mg Er","code_information":[{"code":"CP17744631829864844","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382047906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fesoterodine Tab 8mg Er","code_information":[{"code":"CP17744631829865325","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382048006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Methotrexate Inj 50mg/2ml","code_information":[{"code":"CP17744631830444018","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729027730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Terbinafine  Tab 250mg","code_information":[{"code":"CP17744631831117981","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714079502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831253252","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714004401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Aerosol Mask Mis Adult","code_information":[{"code":"CP17744631828361903","type":"CDM"},{"code":"250","type":"RC"},{"code":"83490044079","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anastrozole  Tab 1mg","code_information":[{"code":"CP17744631828534618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991062033","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Anastrozole 1mg Tabs","code_information":[{"code":"CP17744631828533586","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991062010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aripiprazole Tab 15mg","code_information":[{"code":"CP17744631828741469","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714014401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aug Betamet  Cre 0.05%","code_information":[{"code":"CP17744631828791976","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802037635","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Beta Diprop  Cre 0.05%","code_information":[{"code":"CP17744631828868385","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802037635","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Calamine     Lot 8-8%","code_information":[{"code":"CP17744631829055775","type":"CDM"},{"code":"250","type":"RC"},{"code":"90425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Calamine 8-8% Lotion","code_information":[{"code":"CP17744631829054860","type":"CDM"},{"code":"250","type":"RC"},{"code":"90425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Cefadroxil   Tab 1gm","code_information":[{"code":"CP17744631829144595","type":"CDM"},{"code":"250","type":"RC"},{"code":"93405","type":"CPT","modifier":"953"}],"standard_charges":[{"setting":"outpatient","modifier_code":["953"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cyclopentol  Sol 1% Op","code_information":[{"code":"CP17744631829447470","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dimetapp Cold & Allergy","code_information":[{"code":"CP17744631829707700","type":"CDM"},{"code":"250","type":"RC"},{"code":"69536030504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fenofibrate  Tab 40mg","code_information":[{"code":"CP17744631829856171","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682049090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluvastatin  Tab 80mg Er","code_information":[{"code":"CP17744631829983690","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Isradipine   Cap 5mg","code_information":[{"code":"CP17744631830163417","type":"CDM"},{"code":"250","type":"RC"},{"code":"16252054001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Keppra       Sol 100mg/ml","code_information":[{"code":"CP17744631830188138","type":"CDM"},{"code":"250","type":"RC"},{"code":"50474000148","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ketorolac    Inj 30mg/ml","code_information":[{"code":"CP17744631830199045","type":"CDM"},{"code":"250","type":"RC"},{"code":"40937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830337184","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858011830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metafolbic   Tab Plus","code_information":[{"code":"CP17744631830434933","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991081190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine   Tab 5mg","code_information":[{"code":"CP17744631830668749","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine   Tab 7.5mg","code_information":[{"code":"CP17744631830661878","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Olanzapine 7.5mg Tabs","code_information":[{"code":"CP17744631830675889","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oxandrolone  Tab 2.5mg","code_information":[{"code":"CP17744631830701908","type":"CDM"},{"code":"250","type":"RC"},{"code":"24502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Oxybutynin   Tab 2.5mg","code_information":[{"code":"CP17744631830705840","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980053101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pantoprazole 40mg/100ml Ns","code_information":[{"code":"CP17744631830735055","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Quetiapine   Tab 400mg","code_information":[{"code":"CP17744631830864173","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877024810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831044785","type":"CDM"},{"code":"250","type":"RC"},{"code":"17271070107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Testosterone Gel 1.62%","code_information":[{"code":"CP17744631831110092","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714096802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobramycin   Sol 0.3% Op","code_information":[{"code":"CP17744631831143957","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Vancomycin   Sol 250/5ml","code_information":[{"code":"CP17744631831236938","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559083055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Anastrozole  Tab 1mg","code_information":[{"code":"CP17744631828534112","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155085705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Anastrozole  Tab 1mg","code_information":[{"code":"CP17744631828538626","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729003515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Anastrozole  Tab 1mg","code_information":[{"code":"CP17744631828532708","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729003510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Anastrozole  Tab 1mg","code_information":[{"code":"CP17744631828537373","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651023690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bacit/hydrocort/nyst/zno","code_information":[{"code":"CP17744631828827820","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glycopyrrol  Inj 0.2mg/ml","code_information":[{"code":"CP17744631830052673","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288041403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Hydrocort    Cre 1%","code_information":[{"code":"CP17744631830106246","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort/ Dibucaine","code_information":[{"code":"CP17744631830111853","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocorticosne/ Dibucaine","code_information":[{"code":"CP17744631830114350","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocorticosne/ Eucerin","code_information":[{"code":"CP17744631830112739","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metoprol Suc Tab 100mg Er","code_information":[{"code":"CP17744631830465425","type":"CDM"},{"code":"250","type":"RC"},{"code":"72516003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nasal Relief Spr 0.05%","code_information":[{"code":"CP17744631830548134","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Oxymetazoline 0.05% Nasal Spr","code_information":[{"code":"CP17744631830724058","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Oxymetazoline Hcl 0.05%","code_information":[{"code":"CP17744631830727448","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paliperidone Tab Er 1.5mg","code_information":[{"code":"CP17744631830725795","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722031730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paliperidone Tab Er 3mg","code_information":[{"code":"CP17744631830724010","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722031830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Prevagen     Cap 10mg","code_information":[{"code":"CP17744631830826232","type":"CDM"},{"code":"250","type":"RC"},{"code":"94047000103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prevagen 10mg Caps","code_information":[{"code":"CP17744631830822867","type":"CDM"},{"code":"250","type":"RC"},{"code":"94047000103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sildenafil   Tab 100mg","code_information":[{"code":"CP17744631831016404","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Sildenafil   Tab 50mg","code_information":[{"code":"CP17744631831014603","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831096144","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Vaseline Petroleum Jelly","code_information":[{"code":"CP17744631831252744","type":"CDM"},{"code":"250","type":"RC"},{"code":"52123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acetazolamid Tab 250mg","code_information":[{"code":"CP17744631828254737","type":"CDM"},{"code":"250","type":"RC"},{"code":"52710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Creon        Cap 6000unit","code_information":[{"code":"CP17744631829426738","type":"CDM"},{"code":"250","type":"RC"},{"code":"32120","type":"CPT","modifier":"607"}],"standard_charges":[{"setting":"outpatient","modifier_code":["607"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6000,"type":"UN"}},{"description":"Creon 6000iu Caps","code_information":[{"code":"CP17744631829439681","type":"CDM"},{"code":"250","type":"RC"},{"code":"32120","type":"CPT","modifier":"607"}],"standard_charges":[{"setting":"outpatient","modifier_code":["607"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6000,"type":"F2"}},{"description":"Erythromycin Tab 250mg","code_information":[{"code":"CP17744631829809632","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710104703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Erythromycin Tab 250mg Bs","code_information":[{"code":"CP17744631829803082","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834024201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Erythromycin Tab 250mg Bs","code_information":[{"code":"CP17744631829807872","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834024230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Erythromycin Tab 250mg Bs","code_information":[{"code":"CP17744631829805492","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668060630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Hydromorphon Tab 2mg","code_information":[{"code":"CP17744631830110588","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858030125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Methylpred   Tab 4mg","code_information":[{"code":"CP17744631830458579","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746000103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Pitavastatin Tab 4mg","code_information":[{"code":"CP17744631830784501","type":"CDM"},{"code":"250","type":"RC"},{"code":"48036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Sevelamer    Tab 400mg","code_information":[{"code":"CP17744631831011845","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044626","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Sevelamer Hcl Tab 400mg","code_information":[{"code":"CP17744631831017700","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044626","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Sod Thiosulf 12.5gm/100ml","code_information":[{"code":"CP17744631831046835","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Sod Thiosulf 12.5gm/150ml","code_information":[{"code":"CP17744631831044395","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Sod Thiosulf 25gm/200ml","code_information":[{"code":"CP17744631831043335","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Sod Thiosulf 25grams/100ml","code_information":[{"code":"CP17744631831048393","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Sod Thiosulf Inj 25%","code_information":[{"code":"CP17744631831043978","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Sodiumthio25g/100mlns","code_information":[{"code":"CP17744631831058634","type":"CDM"},{"code":"250","type":"RC"},{"code":"60267070550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"GR"}},{"description":"Trimethoprim Tab 100mg","code_information":[{"code":"CP17744631831195469","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907004301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Vitamin D3 125mcg 5000iu","code_information":[{"code":"CP17744631831295063","type":"CDM"},{"code":"250","type":"RC"},{"code":"10939953705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Bd Posiflush Inj 3ml","code_information":[{"code":"CP17744631828843481","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306544","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Bupren/nalox Sub 8-2mg","code_information":[{"code":"CP17744631828977849","type":"CDM"},{"code":"250","type":"RC"},{"code":"12120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Calcipotrien Oin Betameth","code_information":[{"code":"CP17744631829060752","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993093861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxycycl Hyc Tab 100mg Dr","code_information":[{"code":"CP17744631829746478","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155014201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Erythromycin 5mg/gm Oint","code_information":[{"code":"CP17744631829803751","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gentamicin   Cre 0.1%","code_information":[{"code":"CP17744631830027605","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentamicin 0.1% Cream","code_information":[{"code":"CP17744631830022789","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Lock Inj 100/ml","code_information":[{"code":"CP17744631830078053","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323054501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Indomethacin Cap 25mg","code_information":[{"code":"CP17744631830137353","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462040601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Norml Saline Inj Iv Flush","code_information":[{"code":"CP17744631830573498","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306544","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pimecrolimus Cre 1%","code_information":[{"code":"CP17744631830774344","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682011001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831055159","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877052790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831147970","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241019190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831148623","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241019130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831146408","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241019290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831143182","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722060830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Toprol Xl    Tab 100mg","code_information":[{"code":"CP17744631831158955","type":"CDM"},{"code":"250","type":"RC"},{"code":"70347010002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Alprazolam   Tab 0.5mg","code_information":[{"code":"CP17744631828445786","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Benzonatate  Cap 200mg","code_information":[{"code":"CP17744631828863653","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224000160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Benzonatate 200mg Caps","code_information":[{"code":"CP17744631828860849","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224000160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Captopril    Tab 100mg","code_information":[{"code":"CP17744631829102082","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241016301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dorzolamide  Sol 2% Op","code_information":[{"code":"CP17744631829724856","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lamotrigine  Tab 50mg Er","code_information":[{"code":"CP17744631830210087","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lamotrigine Er 50mg Tabs","code_information":[{"code":"CP17744631830215077","type":"CDM"},{"code":"250","type":"RC"},{"code":"22814","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lorazepam    Inj 2mg/ml","code_information":[{"code":"CP17744631830362459","type":"CDM"},{"code":"250","type":"RC"},{"code":"40967","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Terbinafine  Tab 250mg","code_information":[{"code":"CP17744631831110645","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991052601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831119222","type":"CDM"},{"code":"250","type":"RC"},{"code":"59141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Thiamine Hcl Inj 200/2ml","code_information":[{"code":"CP17744631831125036","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748034702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Vitamin D3   Tab 400unit","code_information":[{"code":"CP17744631831290451","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268086315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"UN"}},{"description":"Bromocriptin Cap 5mg","code_information":[{"code":"CP17744631828958135","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clomipramine Cap 75mg","code_information":[{"code":"CP17744631829374991","type":"CDM"},{"code":"250","type":"RC"},{"code":"40688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Exemestane   Tab 25mg","code_information":[{"code":"CP17744631829831584","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097031602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Loofah Pad","code_information":[{"code":"CP17744631830354800","type":"CDM"},{"code":"250","type":"RC"},{"code":"60629200109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methazolamid Tab 50mg","code_information":[{"code":"CP17744631830447061","type":"CDM"},{"code":"250","type":"RC"},{"code":"57407","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Methylpred   Tab 16mg","code_information":[{"code":"CP17744631830455473","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762005001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831098237","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722064430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831097620","type":"CDM"},{"code":"250","type":"RC"},{"code":"93301","type":"CPT","modifier":"756"}],"standard_charges":[{"setting":"outpatient","modifier_code":["756"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831093769","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268073813","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831097578","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332017830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tazarotene   Cre 0.1%","code_information":[{"code":"CP17744631831103988","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672137302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carbamazepin Tab 400mg Er","code_information":[{"code":"CP17744631829127434","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714006501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Cefazol3g In Ns","code_information":[{"code":"CP17744631829148681","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefazol3g/ns","code_information":[{"code":"CP17744631829140300","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Cefazolin    Inj 1gm","code_information":[{"code":"CP17744631829141142","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefazolin 1 Gm/50 Ml Ns Mb","code_information":[{"code":"CP17744631829147332","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefazolin 1gm Inj Vial","code_information":[{"code":"CP17744631829144742","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefazolin 1gm/50ml D5w","code_information":[{"code":"CP17744631829144728","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefazolin 1gm/50ml El-d","code_information":[{"code":"CP17744631829155558","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefazolin 2 Gm/100 Ml Ns Mb+","code_information":[{"code":"CP17744631829159732","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml D5w","code_information":[{"code":"CP17744631829158297","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 2gm/100ml Ns","code_information":[{"code":"CP17744631829153544","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Cefazolin 3 Gm/100 Ml Ns","code_information":[{"code":"CP17744631829157737","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505614205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Coricidin Hbp 10/200mg","code_information":[{"code":"CP17744631829426729","type":"CDM"},{"code":"250","type":"RC"},{"code":"11523715802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Gent 240mg / Ns 500ml Bottle","code_information":[{"code":"CP17744631830027386","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Gent 528mg /Ster Water 1000ml","code_information":[{"code":"CP17744631830027965","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":528,"type":"ME"}},{"description":"Gent 80mg /Ster Water 1000ml","code_information":[{"code":"CP17744631830029374","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Genta 480mg/ns 0.9% Irr 1000ml","code_information":[{"code":"CP17744631830028978","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":480,"type":"ME"}},{"description":"Gentamicin   Inj 40mg/ml","code_information":[{"code":"CP17744631830024120","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gentamicin 132mg/250ml Ste H20","code_information":[{"code":"CP17744631830032563","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":132,"type":"ME"}},{"description":"Gentamicin 240mg/500ml Ns Irr.","code_information":[{"code":"CP17744631830035198","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Gentamicin 264mg/500ml","code_information":[{"code":"CP17744631830033490","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":264,"type":"ME"}},{"description":"Gentamicin 340mg/100ml Ns","code_information":[{"code":"CP17744631830033951","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":340,"type":"ME"}},{"description":"Gentamicin 350mg/100ml","code_information":[{"code":"CP17744631830035144","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Gentamicin 380mg/100ml Ns","code_information":[{"code":"CP17744631830030354","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":380,"type":"ME"}},{"description":"Gentamicin 400mg/100ml","code_information":[{"code":"CP17744631830032076","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Gentamicin 450mg/100ml","code_information":[{"code":"CP17744631830035155","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Gentamicin 600mg/250ml Ns","code_information":[{"code":"CP17744631830035761","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Gentamycin  290mg/100ml","code_information":[{"code":"CP17744631830033389","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":290,"type":"ME"}},{"description":"Gentamycin 240mg / Ns 0.95 Irr","code_information":[{"code":"CP17744631830035315","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Gentamycin 600mg/250ml Ns","code_information":[{"code":"CP17744631830037561","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Kapspargo    Cap 25mg","code_information":[{"code":"CP17744631830180196","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631000830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lansoprazole Sus 3mg/ml","code_information":[{"code":"CP17744631830219651","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628008003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Lanthanum    Chw 500mg","code_information":[{"code":"CP17744631830217973","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993042247","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Primaquine   Tab 26.3mg","code_information":[{"code":"CP17744631830837742","type":"CDM"},{"code":"250","type":"RC"},{"code":"24159","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":263,"type":"ME"}},{"description":"Primaquine 26.3mg Tabs","code_information":[{"code":"CP17744631830838592","type":"CDM"},{"code":"250","type":"RC"},{"code":"24159","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":263,"type":"ME"}},{"description":"Bethanechol  Tab 25mg","code_information":[{"code":"CP17744631828874872","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746057301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"But/apap/caff 50-325-40mg Tab","code_information":[{"code":"CP17744631829040674","type":"CDM"},{"code":"250","type":"RC"},{"code":"46672005350","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Doxercalcif  Inj 4mcg/2ml","code_information":[{"code":"CP17744631829737815","type":"CDM"},{"code":"250","type":"RC"},{"code":"40913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Febuxostat   Tab 80mg","code_information":[{"code":"CP17744631829848054","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332019130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Gengraf      Cap 25mg","code_information":[{"code":"CP17744631830024385","type":"CDM"},{"code":"250","type":"RC"},{"code":"74310","type":"CPT","modifier":"832"}],"standard_charges":[{"setting":"outpatient","modifier_code":["832"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methylfol/ca Tab Me-cbl","code_information":[{"code":"CP17744631830447010","type":"CDM"},{"code":"250","type":"RC"},{"code":"76439040290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Milk Of Magn Sus 400/5ml","code_information":[{"code":"CP17744631830484027","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896064916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Pilocarpine  Sol 2% Op","code_information":[{"code":"CP17744631830775461","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069019101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830879882","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831043595","type":"CDM"},{"code":"250","type":"RC"},{"code":"17271070106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Danazol      Cap 200mg","code_information":[{"code":"CP17744631829471766","type":"CDM"},{"code":"250","type":"RC"},{"code":"55506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Deep Sea     Spr 0.65%","code_information":[{"code":"CP17744631829545004","type":"CDM"},{"code":"250","type":"RC"},{"code":"90438","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829997712","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603062030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830537737","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084029121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830673117","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884079011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxazepam     Cap 10mg","code_information":[{"code":"CP17744631830700614","type":"CDM"},{"code":"250","type":"RC"},{"code":"62584081201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Phospho-trin Tab 250 Neut","code_information":[{"code":"CP17744631830764395","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328010710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Pyrazinamide Tab 500mg","code_information":[{"code":"CP17744631830854673","type":"CDM"},{"code":"250","type":"RC"},{"code":"61748001206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Saline Nasal Spray 0.65%","code_information":[{"code":"CP17744631830938226","type":"CDM"},{"code":"250","type":"RC"},{"code":"90438","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Terbinafine  Tab 250mg","code_information":[{"code":"CP17744631831118711","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862007930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Bupropion    Tab 100mg Sr","code_information":[{"code":"CP17744631828983628","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547028850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Isopto Tears Sol 0.5% Op","code_information":[{"code":"CP17744631830161314","type":"CDM"},{"code":"250","type":"RC"},{"code":"99804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Octreotide   Inj 50mcg/ml","code_information":[{"code":"CP17744631830652667","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cytomel      Tab 5mcg","code_information":[{"code":"CP17744631829442818","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793011501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dronabinol   Cap 2.5mg","code_information":[{"code":"CP17744631829740374","type":"CDM"},{"code":"250","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Famciclovir  Tab 500mg","code_information":[{"code":"CP17744631829838666","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342002607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Famciclovir  Tab 500mg","code_information":[{"code":"CP17744631829836260","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722070830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Heparin Sod  Inj 10000/ml","code_information":[{"code":"CP17744631830071910","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457060399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Methenam Man Tab 1000mg","code_information":[{"code":"CP17744631830440677","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135020160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Methylphenid Tab 5mg","code_information":[{"code":"CP17744631830458986","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084080521","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Naproxen Dr  Tab 375mg","code_information":[{"code":"CP17744631830545913","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543042510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Nitrofur Mac Cap 25mg","code_information":[{"code":"CP17744631830561820","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756041011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nitrofurantoin Macro 25mg Caps","code_information":[{"code":"CP17744631830565842","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781030601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pain Ease    Aer Mist","code_information":[{"code":"CP17744631830729257","type":"CDM"},{"code":"250","type":"RC"},{"code":"38600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paricalcitol Inj 5mcg/ml","code_information":[{"code":"CP17744631830733065","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457038025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pilocarpine  Sol 4% Op","code_information":[{"code":"CP17744631830774918","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069020101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831046371","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sodium Chlo-0.9% Iv Bag 500ml","code_information":[{"code":"CP17744631831046575","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Sodium Chloride-0.9% 500ml Iv","code_information":[{"code":"CP17744631831049216","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ML"}},{"description":"Terbinafine  Tab 250mg","code_information":[{"code":"CP17744631831113469","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714079501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Valacyclovir Tab 1gm","code_information":[{"code":"CP17744631831211641","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746032530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Valacyclovir Tab 1gm","code_information":[{"code":"CP17744631831216514","type":"CDM"},{"code":"250","type":"RC"},{"code":"37842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Calcipotrien Oin Betameth","code_information":[{"code":"CP17744631829061036","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993093865","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carvedilol   Tab 3.125mg","code_information":[{"code":"CP17744631829139493","type":"CDM"},{"code":"250","type":"RC"},{"code":"90463","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3125,"type":"ME"}},{"description":"Cefpodoxime  Tab 100mg","code_information":[{"code":"CP17744631829176351","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877087820","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mag Citrate  Sol Lemon","code_information":[{"code":"CP17744631830396802","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011038001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830538939","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094085362","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Thermacare Neck/wrs","code_information":[{"code":"CP17744631831127334","type":"CDM"},{"code":"250","type":"RC"},{"code":"57330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonazep Odt Tab 0.25mg","code_information":[{"code":"CP17744631829374040","type":"CDM"},{"code":"250","type":"RC"},{"code":"93929","type":"CPT","modifier":"167"}],"standard_charges":[{"setting":"outpatient","modifier_code":["167"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clonazepam Odt 0.25mg Tbdp","code_information":[{"code":"CP17744631829373684","type":"CDM"},{"code":"250","type":"RC"},{"code":"93929","type":"CPT","modifier":"167"}],"standard_charges":[{"setting":"outpatient","modifier_code":["167"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dextrose     Inj 5%","code_information":[{"code":"CP17744631829587218","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dextrose Inj 5%  250ml","code_information":[{"code":"CP17744631829581740","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Diltiazem    Tab 60mg","code_information":[{"code":"CP17744631829696424","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228048201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Diltiazem    Tab 60mg","code_information":[{"code":"CP17744631829699130","type":"CDM"},{"code":"250","type":"RC"},{"code":"93031","type":"CPT","modifier":"901"}],"standard_charges":[{"setting":"outpatient","modifier_code":["901"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Diltiazem Hcl Tab 60mg","code_information":[{"code":"CP17744631829704367","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228048201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dressing Change Kit","code_information":[{"code":"CP17744631829745492","type":"CDM"},{"code":"250","type":"RC"},{"code":"10055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hollister Pouch 18004","code_information":[{"code":"CP17744631830082018","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380018004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Dressing Change","code_information":[{"code":"CP17744631830179610","type":"CDM"},{"code":"250","type":"RC"},{"code":"10055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Leucovor Ca  Tab 10mg","code_information":[{"code":"CP17744631830292357","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806013324","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mesalamine   Cap 0.375gm","code_information":[{"code":"CP17744631830427729","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682011320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Morphine 2mg/ml Inj Soln","code_information":[{"code":"CP17744631830506617","type":"CDM"},{"code":"250","type":"RC"},{"code":"40918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Morphine Sul Inj 2mg/ml","code_information":[{"code":"CP17744631830503172","type":"CDM"},{"code":"250","type":"RC"},{"code":"40918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Naftifine    Cre Hcl 1%","code_information":[{"code":"CP17744631830538953","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672136208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thiamine Hcl Inj 200/2ml","code_information":[{"code":"CP17744631831127114","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603013925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Valacyclovir Tab 1gm","code_information":[{"code":"CP17744631831213390","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Amiodarone 100mg Tabs","code_information":[{"code":"CP17744631828478182","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862024030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Blistex      Oin Medicate","code_information":[{"code":"CP17744631828937513","type":"CDM"},{"code":"250","type":"RC"},{"code":"10157995102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Blistex Oint 2288 0.21oz","code_information":[{"code":"CP17744631828932104","type":"CDM"},{"code":"250","type":"RC"},{"code":"10157995102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2288,"type":"EA"}},{"description":"Dulcolax     Sup 10mg","code_information":[{"code":"CP17744631829757224","type":"CDM"},{"code":"250","type":"RC"},{"code":"81421002101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Konvomep     Sus 2-84/ml","code_information":[{"code":"CP17744631830195196","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628027205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"S2           Neb 2.25%","code_information":[{"code":"CP17744631830927355","type":"CDM"},{"code":"250","type":"RC"},{"code":"48759","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"S2 Racepine Inh 2.25% 30ml","code_information":[{"code":"CP17744631830922059","type":"CDM"},{"code":"250","type":"RC"},{"code":"48759","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Sm Tussin Dm Liq 20-200mg","code_information":[{"code":"CP17744631831035960","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677013901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tussin Dm 200-20 Mg/20ml","code_information":[{"code":"CP17744631831200647","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677013901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Varenicline  Tab 1mg","code_information":[{"code":"CP17744631831249880","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722067956","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Xerofrm Gauz Mis 5\"x9\"","code_information":[{"code":"CP17744631831386680","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080433605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bd 5ml Syrg  Mis Luer-lok","code_information":[{"code":"CP17744631828845065","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290309703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Creon        Cap 3000unit","code_information":[{"code":"CP17744631829427176","type":"CDM"},{"code":"250","type":"RC"},{"code":"32120","type":"CPT","modifier":"370"}],"standard_charges":[{"setting":"outpatient","modifier_code":["370"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3000,"type":"UN"}},{"description":"Creon        Cap 3000unit","code_information":[{"code":"CP17744631829425091","type":"CDM"},{"code":"250","type":"RC"},{"code":"32004","type":"CPT","modifier":"570"}],"standard_charges":[{"setting":"outpatient","modifier_code":["570"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3000,"type":"UN"}},{"description":"Creon-3000iu-cpep","code_information":[{"code":"CP17744631829436923","type":"CDM"},{"code":"250","type":"RC"},{"code":"32120","type":"CPT","modifier":"370"}],"standard_charges":[{"setting":"outpatient","modifier_code":["370"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3000,"type":"F2"}},{"description":"Dexmethylphe Cap Er 25mg","code_information":[{"code":"CP17744631829576162","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884033301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Endocet      Tab 2.5-325","code_information":[{"code":"CP17744631829777886","type":"CDM"},{"code":"250","type":"RC"},{"code":"60951070170","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829849802","type":"CDM"},{"code":"250","type":"RC"},{"code":"52722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829843634","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808020601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Febuxostat   Tab 80mg","code_information":[{"code":"CP17744631829840221","type":"CDM"},{"code":"250","type":"RC"},{"code":"52722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Hydrocell Foam Dressing","code_information":[{"code":"CP17744631830099602","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247919335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Primary Pump Tubing","code_information":[{"code":"CP17744631830172939","type":"CDM"},{"code":"250","type":"RC"},{"code":"8541205170","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Tab 54mg Er","code_information":[{"code":"CP17744631830452152","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162023709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":54,"type":"ME"}},{"description":"Roflumilast  Tab 500mcg","code_information":[{"code":"CP17744631830917992","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Silicone Foam Dress 4x4","code_information":[{"code":"CP17744631831018936","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247919335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831050631","type":"CDM"},{"code":"250","type":"RC"},{"code":"35561028511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Valacyclovir Tab 1gm","code_information":[{"code":"CP17744631831218479","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862044930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ampicillin   Inj 500mg","code_information":[{"code":"CP17744631828522491","type":"CDM"},{"code":"250","type":"RC"},{"code":"78134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Armour Thyro Tab 90mg","code_information":[{"code":"CP17744631828750927","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Calcitriol   Cap 0.5mcg","code_information":[{"code":"CP17744631829061705","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155066301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Candesartan  Tab 32mg","code_information":[{"code":"CP17744631829092669","type":"CDM"},{"code":"250","type":"RC"},{"code":"37832","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Cloraz Dipot Tab 15mg","code_information":[{"code":"CP17744631829384994","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Clozapine    Tab 25mg Odt","code_information":[{"code":"CP17744631829395146","type":"CDM"},{"code":"250","type":"RC"},{"code":"93541","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clozapine Odt 25mg Tabs","code_information":[{"code":"CP17744631829393240","type":"CDM"},{"code":"250","type":"RC"},{"code":"93541","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ddrops       Liq","code_information":[{"code":"CP17744631829547448","type":"CDM"},{"code":"250","type":"RC"},{"code":"51228000009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac   Tab 100mg Er","code_information":[{"code":"CP17744631829595195","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682010301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829983340","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714000501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Guaiasorb Dm Liq 100-10/5","code_information":[{"code":"CP17744631830065211","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896073604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Simethicone  Dro Infants","code_information":[{"code":"CP17744631831021397","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831092686","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729037010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831091919","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547004903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831090090","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335001083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831090982","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241011203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cyclosporine Emu 0.05%","code_information":[{"code":"CP17744631829446937","type":"CDM"},{"code":"250","type":"RC"},{"code":"37887","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Emu 0.05% Op","code_information":[{"code":"CP17744631829446116","type":"CDM"},{"code":"250","type":"RC"},{"code":"37887","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dorzol/timol Sol 2-0.5%op","code_information":[{"code":"CP17744631829720536","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377008211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 2-0.5%op","code_information":[{"code":"CP17744631829723796","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383023310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829724371","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383023310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829723091","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314003002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Dorzol/timol Sol 22.3-6.8","code_information":[{"code":"CP17744631829729026","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377008211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":223,"type":"EA"}},{"description":"Doxepin      Tab 3mg","code_information":[{"code":"CP17744631829731698","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135075830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Icy Hot      Pad 5%","code_information":[{"code":"CP17744631830133623","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167000841","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Icy Hot Back Pad 5%","code_information":[{"code":"CP17744631830133533","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167000843","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methadone    Con 10mg/ml","code_information":[{"code":"CP17744631830444378","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689069430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tadalafil    Tab 2.5mg","code_information":[{"code":"CP17744631831098398","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238134603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831094977","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668056630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831099279","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300028713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Vial-mate Vial Adapter","code_information":[{"code":"CP17744631831260818","type":"CDM"},{"code":"250","type":"RC"},{"code":"85412027383","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Arthrts Pain Tab 650mg","code_information":[{"code":"CP17744631828759808","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660033301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Band-aid     Mis Kling","code_information":[{"code":"CP17744631828837298","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137116137","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bandaid Fa Rlld 2\" X 2.5yd Msc","code_information":[{"code":"CP17744631828830323","type":"CDM"},{"code":"250","type":"RC"},{"code":"38137116137","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupren/nalox Mis 4-1mg","code_information":[{"code":"CP17744631828977256","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Erythromycin Tab 250mg Ec","code_information":[{"code":"CP17744631829801849","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668058630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Icosapent    Cap 1gm","code_information":[{"code":"CP17744631830131778","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598026704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830212827","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918038030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine Odt-200mg","code_information":[{"code":"CP17744631830211471","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918038030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Metronidazol Gel 1%","code_information":[{"code":"CP17744631830476523","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672416403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olmesart/amlodip/hctz 40/5/25m","code_information":[{"code":"CP17744631830672241","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884078811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pyrazinamide Tab 500mg","code_information":[{"code":"CP17744631830850475","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954048410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Tramadol Er 300mg Tabs","code_information":[{"code":"CP17744631831152783","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180069906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Tramadol Hcl Tab 300mg Er","code_information":[{"code":"CP17744631831162133","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180069906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Verapamil    Cap 180mg Sr","code_information":[{"code":"CP17744631831266056","type":"CDM"},{"code":"250","type":"RC"},{"code":"59128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Cefdinir     Cap 300mg","code_information":[{"code":"CP17744631829152422","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877054360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Dilantin     Cap 100mg","code_information":[{"code":"CP17744631829607473","type":"CDM"},{"code":"250","type":"RC"},{"code":"71036","type":"CPT","modifier":"924"}],"standard_charges":[{"setting":"outpatient","modifier_code":["924"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dilantin     Cap 100mg","code_information":[{"code":"CP17744631829603962","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151011001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dilantin     Cap 100mg","code_information":[{"code":"CP17744631829607291","type":"CDM"},{"code":"250","type":"RC"},{"code":"71036","type":"CPT","modifier":"932"}],"standard_charges":[{"setting":"outpatient","modifier_code":["932"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Eszopiclone  Tab 1mg","code_information":[{"code":"CP17744631829828402","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342029907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Eszopiclone  Tab 2mg","code_information":[{"code":"CP17744631829825811","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342030011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Eszopiclone  Tab 3mg","code_information":[{"code":"CP17744631829827142","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342030111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Haloper Lac  Inj 5mg/ml","code_information":[{"code":"CP17744631830065265","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Iv Extension 7\" Set","code_information":[{"code":"CP17744631830178756","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784070612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Extension Mis 7\"","code_information":[{"code":"CP17744631830170463","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784070612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pitavastatin Tab 1mg","code_information":[{"code":"CP17744631830782164","type":"CDM"},{"code":"250","type":"RC"},{"code":"48036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Pitavastatin Tab 2mg","code_information":[{"code":"CP17744631830789367","type":"CDM"},{"code":"250","type":"RC"},{"code":"48036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Promethazine Inj 25mg/ml","code_information":[{"code":"CP17744631830849209","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822552503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Flecainide   Tab 100mg","code_information":[{"code":"CP17744631829955346","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746064201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lorazepam    Tab 1mg","code_information":[{"code":"CP17744631830360432","type":"CDM"},{"code":"250","type":"RC"},{"code":"93342","type":"CPT","modifier":"605"}],"standard_charges":[{"setting":"outpatient","modifier_code":["605"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Np Thyroid   Tab 120mg","code_information":[{"code":"CP17744631830645613","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192032801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Paroxetine   Cap 7.5mg","code_information":[{"code":"CP17744631830732995","type":"CDM"},{"code":"250","type":"RC"},{"code":"57402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Testost Cyp  Inj 200mg/ml","code_information":[{"code":"CP17744631831110791","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150027801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Thyroid 120mg Tabs","code_information":[{"code":"CP17744631831125442","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192032801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Albumin Hum  Inj 25%","code_information":[{"code":"CP17744631828376645","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206025105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Amlod/benazp Cap 5-40mg","code_information":[{"code":"CP17744631828481037","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111058701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cyclopentol  Sol 1% Op","code_information":[{"code":"CP17744631829448929","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314039603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Sod  Inj 5000/ml","code_information":[{"code":"CP17744631830087464","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Linezolid    Sus 100/5ml","code_information":[{"code":"CP17744631830349120","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762130801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Maalb12.5g","code_information":[{"code":"CP17744631830393768","type":"CDM"},{"code":"250","type":"RC"},{"code":"44206025105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"GR"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830442327","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729048601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nitrofur Mac Cap 25mg","code_information":[{"code":"CP17744631830566936","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603018201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Polyeth Glyc Pow 3350 Nf","code_information":[{"code":"CP17744631830786673","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559015730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valacyclovir Tab 1gm","code_information":[{"code":"CP17744631831218971","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237004390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vilazodone   Tab 20mg","code_information":[{"code":"CP17744631831270767","type":"CDM"},{"code":"250","type":"RC"},{"code":"48020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Desvenlafax  Tab 25mg Er","code_information":[{"code":"CP17744631829569300","type":"CDM"},{"code":"250","type":"RC"},{"code":"54060","type":"CPT","modifier":"313"}],"standard_charges":[{"setting":"outpatient","modifier_code":["313"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Desvenlafax  Tab 25mg Er","code_information":[{"code":"CP17744631829579702","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180060406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Desvenlafax  Tab 50mg Er","code_information":[{"code":"CP17744631829578270","type":"CDM"},{"code":"250","type":"RC"},{"code":"54040","type":"CPT","modifier":"13"}],"standard_charges":[{"setting":"outpatient","modifier_code":["13"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hydroco 2.5% Pramoxine 1% Crm","code_information":[{"code":"CP17744631830095363","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802047265","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mask Aerosol Nebulizer Lf","code_information":[{"code":"CP17744631830409740","type":"CDM"},{"code":"250","type":"RC"},{"code":"33413056220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Cap 50mg","code_information":[{"code":"CP17744631830453524","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831040514","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sod Chloride Inj 0.9%  250ml","code_information":[{"code":"CP17744631831042083","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Sod Chloride Inj 0.9% Â 250ml","code_information":[{"code":"CP17744631831047090","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ML"}},{"description":"Capecitabine Tab 150mg","code_information":[{"code":"CP17744631829103127","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714046701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Diltiazem    Tab 300mg Er","code_information":[{"code":"CP17744631829696831","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436019804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Drainable Pouch 401512","code_information":[{"code":"CP17744631829743981","type":"CDM"},{"code":"250","type":"RC"},{"code":"34015","type":"CPT","modifier":"12"}],"standard_charges":[{"setting":"outpatient","modifier_code":["12"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829842677","type":"CDM"},{"code":"250","type":"RC"},{"code":"37839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829842580","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547029503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829844428","type":"CDM"},{"code":"250","type":"RC"},{"code":"54041","type":"CPT","modifier":"313"}],"standard_charges":[{"setting":"outpatient","modifier_code":["313"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Febuxostat   Tab 80mg","code_information":[{"code":"CP17744631829841665","type":"CDM"},{"code":"250","type":"RC"},{"code":"54041","type":"CPT","modifier":"413"}],"standard_charges":[{"setting":"outpatient","modifier_code":["413"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Fluoxetine   Tab 10mg","code_information":[{"code":"CP17744631829971273","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714011202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"L-methylfola Tab 7.5mg","code_information":[{"code":"CP17744631830354497","type":"CDM"},{"code":"250","type":"RC"},{"code":"76439035990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Mupirocin/desonide Ointment","code_information":[{"code":"CP17744631830520990","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802042335","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclo/misopr Tab 75-0.2mg","code_information":[{"code":"CP17744631829594695","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162043806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Diclofenac   Gel 3%","code_information":[{"code":"CP17744631829594669","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462035594","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Lasix        Tab 80mg","code_information":[{"code":"CP17744631830228916","type":"CDM"},{"code":"250","type":"RC"},{"code":"30698006605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Lidocaine    Inj 2%","code_information":[{"code":"CP17744631830335320","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323020202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Methlphenida Chw 2.5mg","code_information":[{"code":"CP17744631830441419","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722092601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methylphenid Chw 2.5mg","code_information":[{"code":"CP17744631830451004","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722092601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pain Ease    Aer Mist","code_information":[{"code":"CP17744631830725164","type":"CDM"},{"code":"250","type":"RC"},{"code":"38600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paxil        Sus 10mg/5ml","code_information":[{"code":"CP17744631830749017","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505040205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pramipexole  Tab 1mg","code_information":[{"code":"CP17744631830806775","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237018490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Risperidone  Tab 3mg Odt","code_information":[{"code":"CP17744631830902460","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884040291","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Testosterone Gel 1%(25mg)","code_information":[{"code":"CP17744631831117329","type":"CDM"},{"code":"250","type":"RC"},{"code":"59132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Capecitabine Tab 150mg","code_information":[{"code":"CP17744631829105629","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Clindamy/ben Gel 1-5%","code_information":[{"code":"CP17744631829258080","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462048627","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dorzolamide  Sol 2% Op","code_information":[{"code":"CP17744631829721638","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266019701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Glycopyrrol  Inj 0.2mg/ml","code_information":[{"code":"CP17744631830059304","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Hc Butyrate  Cre 0.1%","code_information":[{"code":"CP17744631830079096","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672407401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort    Cre 2.5%","code_information":[{"code":"CP17744631830100375","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydrocortisone 2.5%/tao`","code_information":[{"code":"CP17744631830113942","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Cap 50mg","code_information":[{"code":"CP17744631830456305","type":"CDM"},{"code":"250","type":"RC"},{"code":"93529","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nyst10k-hydroc-zinc Oxide-alum","code_information":[{"code":"CP17744631830641644","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pain & Fever Sus 160/5ml","code_information":[{"code":"CP17744631830723357","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348009334","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Sulfacet Sod Sol 10% Op","code_information":[{"code":"CP17744631831071506","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758001805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Trimo-san    Gel","code_information":[{"code":"CP17744631831192301","type":"CDM"},{"code":"250","type":"RC"},{"code":"59365503000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triple Antib Oin","code_information":[{"code":"CP17744631831194310","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Budesonide   Sus 1mg/2ml","code_information":[{"code":"CP17744631828961438","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714002030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Escitalopram 20mg Tabs","code_information":[{"code":"CP17744631829818424","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547028211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Escitalopram Tab 10mg","code_information":[{"code":"CP17744631829816592","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862037401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Escitalopram Tab 20mg","code_information":[{"code":"CP17744631829818540","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547028211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Escitalopram Tab 5mg","code_information":[{"code":"CP17744631829812975","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862037305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Eszopiclone  Tab 1mg","code_information":[{"code":"CP17744631829828271","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111062930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Eszopiclone  Tab 3mg","code_information":[{"code":"CP17744631829827527","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111061701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Eszopiclone  Tab 3mg","code_information":[{"code":"CP17744631829827799","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862096901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Famciclovir  Tab 250mg","code_information":[{"code":"CP17744631829832880","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342002507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829847805","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714005901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Flonase Algy Spr 50mcg","code_information":[{"code":"CP17744631829963936","type":"CDM"},{"code":"250","type":"RC"},{"code":"13505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hemmorex-hc  Sup 25mg","code_information":[{"code":"CP17744631830076944","type":"CDM"},{"code":"250","type":"RC"},{"code":"16477020124","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lutein Plus  Cap 20mg","code_information":[{"code":"CP17744631830384726","type":"CDM"},{"code":"250","type":"RC"},{"code":"40093010074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Metoprol Tar Tab 37.5mg","code_information":[{"code":"CP17744631830463206","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817035810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Pantoprazole 40mg Tabs","code_information":[{"code":"CP17744631830739251","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668042905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Prochlorper  Inj 10mg/2ml","code_information":[{"code":"CP17744631830836926","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prochlorperazine 5mg/ml Inj","code_information":[{"code":"CP17744631830830223","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Quetiapine   Tab 50mg","code_information":[{"code":"CP17744631830860255","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714045302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Quetiapine 50mg Tabs","code_information":[{"code":"CP17744631830861402","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714045302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830879045","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304001860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine Er 1000mg","code_information":[{"code":"CP17744631830876930","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304001860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Uribel       Tab 81.6mg","code_information":[{"code":"CP17744631831218370","type":"CDM"},{"code":"250","type":"RC"},{"code":"17807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":816,"type":"ME"}},{"description":"Vandazole    Gel 0.75%","code_information":[{"code":"CP17744631831249582","type":"CDM"},{"code":"250","type":"RC"},{"code":"24508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Calcitriol   Cap 0.5mcg","code_information":[{"code":"CP17744631829062587","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380072406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cloth Tape   Tap 1\"x10yds","code_information":[{"code":"CP17744631829381969","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917012647","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluphenazine 10mg Tabs","code_information":[{"code":"CP17744631829977183","type":"CDM"},{"code":"250","type":"RC"},{"code":"52717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829971008","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241025201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829972747","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829986400","type":"CDM"},{"code":"250","type":"RC"},{"code":"52717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829983938","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238168101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829980290","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954027610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829983377","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714067501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829988386","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979013901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829986227","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954027620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829985962","type":"CDM"},{"code":"250","type":"RC"},{"code":"90096012401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Heparin Lock Inj 100/ml","code_information":[{"code":"CP17744631830070117","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306423","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Insyte Auto Iv Cath 24gx3/4\"","code_information":[{"code":"CP17744631830158090","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insyte Autog Mis 24gx3/4\"","code_information":[{"code":"CP17744631830156922","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insyte Autoguard 24g 3/4'","code_information":[{"code":"CP17744631830157265","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"GR"}},{"description":"Insyte Autoguard 24gx0.75\" Cat","code_information":[{"code":"CP17744631830153656","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insyte Autoguard Iv Cath","code_information":[{"code":"CP17744631830157227","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290381412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830770937","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862051430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830776833","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237022190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830779545","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830772593","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862051405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830773853","type":"CDM"},{"code":"250","type":"RC"},{"code":"93727","type":"CPT","modifier":"398"}],"standard_charges":[{"setting":"outpatient","modifier_code":["398"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830779758","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342005610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Pioglitazone Tab 45mg","code_information":[{"code":"CP17744631830771190","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Sucralfate   Tab 1gm","code_information":[{"code":"CP17744631831072703","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762040105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Synthroid    Tab 100mcg","code_information":[{"code":"CP17744631831082309","type":"CDM"},{"code":"250","type":"RC"},{"code":"74662","type":"CPT","modifier":"490"}],"standard_charges":[{"setting":"outpatient","modifier_code":["490"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Synthroid    Tab 100mcg","code_information":[{"code":"CP17744631831082715","type":"CDM"},{"code":"250","type":"RC"},{"code":"74662","type":"CPT","modifier":"411"}],"standard_charges":[{"setting":"outpatient","modifier_code":["411"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Synthroid    Tab 112mcg","code_information":[{"code":"CP17744631831083104","type":"CDM"},{"code":"250","type":"RC"},{"code":"74929","type":"CPT","modifier":"690"}],"standard_charges":[{"setting":"outpatient","modifier_code":["690"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":112,"type":"ME"}},{"description":"Synthroid    Tab 125mcg","code_information":[{"code":"CP17744631831085598","type":"CDM"},{"code":"250","type":"RC"},{"code":"74706","type":"CPT","modifier":"890"}],"standard_charges":[{"setting":"outpatient","modifier_code":["890"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Synthroid    Tab 137mcg","code_information":[{"code":"CP17744631831080566","type":"CDM"},{"code":"250","type":"RC"},{"code":"74372","type":"CPT","modifier":"790"}],"standard_charges":[{"setting":"outpatient","modifier_code":["790"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Synthroid    Tab 150mcg","code_information":[{"code":"CP17744631831088031","type":"CDM"},{"code":"250","type":"RC"},{"code":"74706","type":"CPT","modifier":"990"}],"standard_charges":[{"setting":"outpatient","modifier_code":["990"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Synthroid    Tab 175mcg","code_information":[{"code":"CP17744631831084025","type":"CDM"},{"code":"250","type":"RC"},{"code":"74707","type":"CPT","modifier":"90"}],"standard_charges":[{"setting":"outpatient","modifier_code":["90"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":175,"type":"ME"}},{"description":"Synthroid    Tab 200mcg","code_information":[{"code":"CP17744631831089115","type":"CDM"},{"code":"250","type":"RC"},{"code":"74714","type":"CPT","modifier":"890"}],"standard_charges":[{"setting":"outpatient","modifier_code":["890"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Synthroid    Tab 25mcg","code_information":[{"code":"CP17744631831088530","type":"CDM"},{"code":"250","type":"RC"},{"code":"74434","type":"CPT","modifier":"190"}],"standard_charges":[{"setting":"outpatient","modifier_code":["190"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Synthroid    Tab 50mcg","code_information":[{"code":"CP17744631831080491","type":"CDM"},{"code":"250","type":"RC"},{"code":"74455","type":"CPT","modifier":"219"}],"standard_charges":[{"setting":"outpatient","modifier_code":["219"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Synthroid    Tab 50mcg","code_information":[{"code":"CP17744631831089393","type":"CDM"},{"code":"250","type":"RC"},{"code":"74455","type":"CPT","modifier":"211"}],"standard_charges":[{"setting":"outpatient","modifier_code":["211"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Synthroid    Tab 50mcg","code_information":[{"code":"CP17744631831087958","type":"CDM"},{"code":"250","type":"RC"},{"code":"74455","type":"CPT","modifier":"290"}],"standard_charges":[{"setting":"outpatient","modifier_code":["290"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Synthroid    Tab 75mcg","code_information":[{"code":"CP17744631831087433","type":"CDM"},{"code":"250","type":"RC"},{"code":"74518","type":"CPT","modifier":"219"}],"standard_charges":[{"setting":"outpatient","modifier_code":["219"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Synthroid    Tab 88mcg","code_information":[{"code":"CP17744631831088377","type":"CDM"},{"code":"250","type":"RC"},{"code":"74659","type":"CPT","modifier":"490"}],"standard_charges":[{"setting":"outpatient","modifier_code":["490"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"Tramadol Hcl Tab 50mg","code_information":[{"code":"CP17744631831169941","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888008000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin 750 Mg/250 Ml Ns","code_information":[{"code":"CP17744631831241951","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457070500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750mg/250ml Elm","code_information":[{"code":"CP17744631831240364","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457070500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Vancomycin 750mg/250ml Vm","code_information":[{"code":"CP17744631831244717","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457070500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Aqua/nys/zincox/baci","code_information":[{"code":"CP17744631828739024","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bacitracin   Oin 500/gm","code_information":[{"code":"CP17744631828823731","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Cetaphil/triam 0.1%/bacit Oint","code_information":[{"code":"CP17744631829208879","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clindamycin  Cre 2% Vag","code_information":[{"code":"CP17744631829256811","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762500901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Clindamycin 2% Vaginal Cream","code_information":[{"code":"CP17744631829254290","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762500901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Linezolid    Sus 100/5ml","code_information":[{"code":"CP17744631830347344","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687075405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Methylpred   Tab 4mg","code_information":[{"code":"CP17744631830458901","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806040021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Methylprednisolone Dose P-4mg-","code_information":[{"code":"CP17744631830450931","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806040021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Naftifine    Cre Hcl 2%","code_information":[{"code":"CP17744631830539497","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700016117","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Perphen/amit Tab 2-25mg","code_information":[{"code":"CP17744631830756959","type":"CDM"},{"code":"250","type":"RC"},{"code":"37804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pitavastatin Tab 2mg","code_information":[{"code":"CP17744631830781624","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382048216","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Sm Gas Relie Chw 80mg","code_information":[{"code":"CP17744631831035019","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348014707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Triam 0.1/bactro Oint/cetaphil","code_information":[{"code":"CP17744631831174323","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vascepa      Cap 0.5gm","code_information":[{"code":"CP17744631831240336","type":"CDM"},{"code":"250","type":"RC"},{"code":"52937000340","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Amphet/dextr Cap 5mg Er","code_information":[{"code":"CP17744631828516729","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722018501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Budesonide   Sus 0.25mg/2","code_information":[{"code":"CP17744631828952315","type":"CDM"},{"code":"250","type":"RC"},{"code":"48796","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828952884","type":"CDM"},{"code":"250","type":"RC"},{"code":"48797","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Calcipotrien Oin 0.005%","code_information":[{"code":"CP17744631829067053","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993087878","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Decara       Cap 25000unt","code_information":[{"code":"CP17744631829549708","type":"CDM"},{"code":"250","type":"RC"},{"code":"67112090130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25000,"type":"EA"}},{"description":"Desvenlafax  Tab 100mg Er","code_information":[{"code":"CP17744631829564874","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762122203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Desvenlafax  Tab 100mg Er","code_information":[{"code":"CP17744631829562403","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180059306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Desvenlafax  Tab 100mg Er","code_information":[{"code":"CP17744631829564791","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991031290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Desvenlafax  Tab 25mg Er","code_information":[{"code":"CP17744631829562075","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991000690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Desvenlafax  Tab 25mg Er","code_information":[{"code":"CP17744631829574302","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991000633","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Desvenlafax  Tab 25mg Er","code_information":[{"code":"CP17744631829572611","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762121003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Desvenlafax  Tab 50mg Er","code_information":[{"code":"CP17744631829571483","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180059206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Gabapent Dly Tab 300mg","code_information":[{"code":"CP17744631830016232","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722009190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Gabapentin   Tab 300mg","code_information":[{"code":"CP17744631830011491","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722009190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Gabapentin   Tab 600mg","code_information":[{"code":"CP17744631830019613","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722009290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Gabapentin 600mg Tab **Daily**","code_information":[{"code":"CP17744631830011087","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722009290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Lacosamide   Tab 50mg","code_information":[{"code":"CP17744631830203316","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714054801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Lacosamide   Tab 50mg","code_information":[{"code":"CP17744631830200918","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991034806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Levetiraceta Tab 1000mg","code_information":[{"code":"CP17744631830309273","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571079006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Methylphenid Cap 20mg","code_information":[{"code":"CP17744631830447621","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Methylphenidate Cd 20mg Cap","code_information":[{"code":"CP17744631830457062","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ostomy Pouch 8 Inch","code_information":[{"code":"CP17744631830690630","type":"CDM"},{"code":"250","type":"RC"},{"code":"41641","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rabeprazole  Tab 20mg","code_information":[{"code":"CP17744631830875088","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175030232","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rabeprazole  Tab 20mg","code_information":[{"code":"CP17744631830870413","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862072130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rabeprazole  Tab 20mg","code_information":[{"code":"CP17744631830875965","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888005990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rabeprazole  Tab 20mg","code_information":[{"code":"CP17744631830874451","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175030246","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rabeprazole  Tab 20mg","code_information":[{"code":"CP17744631830875614","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888005930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828514573","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722018601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Flunisolide  Spr 0.025%","code_information":[{"code":"CP17744631829967072","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742031725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Iv Set W/flow Regulator","code_information":[{"code":"CP17744631830172934","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"033","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":2,"discounted_cash":2}]},{"description":"Lacosamide   Tab 50mg","code_information":[{"code":"CP17744631830200599","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877073360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Methylphenid Tab 36mg Er","code_information":[{"code":"CP17744631830457932","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162023509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":36,"type":"ME"}},{"description":"Nebivolol    Tab 20mg","code_information":[{"code":"CP17744631830541325","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nebivolol    Tab 5mg","code_information":[{"code":"CP17744631830543221","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ondansetron  Inj 4mg/2ml","code_information":[{"code":"CP17744631830682660","type":"CDM"},{"code":"250","type":"RC"},{"code":"76045021620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Valganciclov Sol 50mg/ml","code_information":[{"code":"CP17744631831227535","type":"CDM"},{"code":"250","type":"RC"},{"code":"71921021012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vesicare Ls  Sus 5mg/5ml","code_information":[{"code":"CP17744631831262562","type":"CDM"},{"code":"250","type":"RC"},{"code":"51248025099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amox/clav 250-125mg Tabs","code_information":[{"code":"CP17744631828499065","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714047601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Amox/k Clav  Tab 250-125","code_information":[{"code":"CP17744631828500322","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714047601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828506775","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714047701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amoxicillin  Sus 400/5ml","code_information":[{"code":"CP17744631828507945","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862007175","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828516995","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010003401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Asperflex    Pad 4%","code_information":[{"code":"CP17744631828768637","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399388406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Celecoxib    Cap 400mg","code_information":[{"code":"CP17744631829180912","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668031060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Clobetasol   Aer 0.05%","code_information":[{"code":"CP17744631829267286","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802063733","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cortef       Tab 10mg","code_information":[{"code":"CP17744631829427469","type":"CDM"},{"code":"250","type":"RC"},{"code":"90031","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diclofenac   Gel 3%","code_information":[{"code":"CP17744631829590315","type":"CDM"},{"code":"250","type":"RC"},{"code":"11514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829724343","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111030230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829720604","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799095402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829729032","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111030290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829723520","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342006110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829729648","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547038203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab Hcl 23mg","code_information":[{"code":"CP17744631829720233","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342006107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab Hcl 23mg","code_information":[{"code":"CP17744631829721009","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111030290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab Hcl 23mg","code_information":[{"code":"CP17744631829723178","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342006110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Fluorouracil Cre 5%","code_information":[{"code":"CP17744631829970919","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862036240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830676355","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884078911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ritonavir    Tab 100mg","code_information":[{"code":"CP17744631830904992","type":"CDM"},{"code":"250","type":"RC"},{"code":"54040","type":"CPT","modifier":"713"}],"standard_charges":[{"setting":"outpatient","modifier_code":["713"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tegretol-xr 100mg Tabs","code_information":[{"code":"CP17744631831101707","type":"CDM"},{"code":"250","type":"RC"},{"code":"78051","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Trospium 20mg Tabs","code_information":[{"code":"CP17744631831199031","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462046160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Trospium Cl  Tab 20mg","code_information":[{"code":"CP17744631831199688","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462046160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vilazodone   Tab 10mg","code_information":[{"code":"CP17744631831272289","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505477203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vilazodone   Tab 10mg","code_information":[{"code":"CP17744631831274872","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505437203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vilazodone   Tab 20mg","code_information":[{"code":"CP17744631831275162","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505477303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vilazodone   Tab 20mg","code_information":[{"code":"CP17744631831276815","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505437303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vilazodone   Tab 40mg","code_information":[{"code":"CP17744631831273586","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505477403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Vilazodone   Tab 40mg","code_information":[{"code":"CP17744631831279963","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505437403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Xerofrm Gauz Mis 5\"x9\"","code_information":[{"code":"CP17744631831383463","type":"CDM"},{"code":"250","type":"RC"},{"code":"8884433605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aspercreme   Pad Lido 4%","code_information":[{"code":"CP17744631828764776","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167005840","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aspercreme Lidocaine 4% Ptch","code_information":[{"code":"CP17744631828765131","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167005840","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Clomipramine Cap 25mg","code_information":[{"code":"CP17744631829375167","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clomipramine Cap 25mg","code_information":[{"code":"CP17744631829375145","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571034201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clomipramine Cap 25mg","code_information":[{"code":"CP17744631829372887","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315016701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829379422","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756040611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829375400","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571034330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829379484","type":"CDM"},{"code":"250","type":"RC"},{"code":"78120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829376429","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180049301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829374409","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714085002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829377603","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710106601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clomipramine Cap 75mg","code_information":[{"code":"CP17744631829373829","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Clomipramine Cap 75mg","code_information":[{"code":"CP17744631829372315","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571068509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Clomipramine Cap 75mg","code_information":[{"code":"CP17744631829378881","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180049401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Dapsone      Gel 7.5%","code_information":[{"code":"CP17744631829476929","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672138803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Ear Drops    Dro 6.5%","code_information":[{"code":"CP17744631829764083","type":"CDM"},{"code":"250","type":"RC"},{"code":"90466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Ear Drops 6.5% Soln","code_information":[{"code":"CP17744631829761004","type":"CDM"},{"code":"250","type":"RC"},{"code":"90466","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829837588","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382077305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829835697","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729043316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829838705","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729043315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829833128","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462022690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829831888","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382077316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829834273","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462022605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Risperidone   Tab 3mg Odt","code_information":[{"code":"CP17744631830901253","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746004022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Risperidone  Tab 3mg Odt","code_information":[{"code":"CP17744631830905329","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746004022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Sore Throat","code_information":[{"code":"CP17744631831052574","type":"CDM"},{"code":"250","type":"RC"},{"code":"90462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sore Throat  Loz 15-3.6mg","code_information":[{"code":"CP17744631831051027","type":"CDM"},{"code":"250","type":"RC"},{"code":"90462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Sore Throat Lozenge","code_information":[{"code":"CP17744631831051180","type":"CDM"},{"code":"250","type":"RC"},{"code":"90462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829248591","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651086701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clotrimazole Sol 1%","code_information":[{"code":"CP17744631829391102","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135067181","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eprontia     Sol 25mg/ml","code_information":[{"code":"CP17744631829795142","type":"CDM"},{"code":"250","type":"RC"},{"code":"52652900101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ezetim/simva Tab 10-40mg","code_information":[{"code":"CP17744631829837529","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963056708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-80mg","code_information":[{"code":"CP17744631829839650","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238115803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe-simvastatin 10/20mg","code_information":[{"code":"CP17744631829832074","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963056608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ivabradine   Tab 7.5mg","code_information":[{"code":"CP17744631830172139","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722005460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Leucovor Ca  Tab 25mg","code_information":[{"code":"CP17744631830291348","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806035925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Onetouch     Tes Ult Blue","code_information":[{"code":"CP17744631830694742","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885099425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Tes Ultra","code_information":[{"code":"CP17744631830691781","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885024450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Tes Ultra","code_information":[{"code":"CP17744631830696838","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885024510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Tes Ultra","code_information":[{"code":"CP17744631830694434","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885099425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Tes Ultra Bl","code_information":[{"code":"CP17744631830694477","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885024510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Tes Ultra Bl","code_information":[{"code":"CP17744631830693079","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885024450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch Ultra Test Strip","code_information":[{"code":"CP17744631830692052","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885099425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prochlorper  Tab 5mg","code_information":[{"code":"CP17744631830835863","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603016801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sucralfate   Tab 1gm","code_information":[{"code":"CP17744631831071410","type":"CDM"},{"code":"250","type":"RC"},{"code":"93221","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Sucralfate 1gm Tabs","code_information":[{"code":"CP17744631831074233","type":"CDM"},{"code":"250","type":"RC"},{"code":"93221","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Theophylline Tab 300mg Er","code_information":[{"code":"CP17744631831129952","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332002531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Torsemide    Tab 10mg","code_information":[{"code":"CP17744631831158476","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268075515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amp 500mg/ 100 Ml","code_information":[{"code":"CP17744631828516484","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ampic 1gm/100ml Sod Cl 0.9%","code_information":[{"code":"CP17744631828529126","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ampicillin   Inj 1gm","code_information":[{"code":"CP17744631828527461","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ampicillin 1gm/50ml Ns","code_information":[{"code":"CP17744631828526633","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Ampicillin 1gm/50ml Ns Mb+","code_information":[{"code":"CP17744631828524121","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Anagrelide   Cap 0.5mg","code_information":[{"code":"CP17744631828531753","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668045301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Anagrelide   Cap 0.5mg","code_information":[{"code":"CP17744631828536178","type":"CDM"},{"code":"250","type":"RC"},{"code":"17252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Anagrelide 0.5mg Caps","code_information":[{"code":"CP17744631828531677","type":"CDM"},{"code":"250","type":"RC"},{"code":"17252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clindamycin  Cap 300mg","code_information":[{"code":"CP17744631829259698","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862018601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Clozapine    Tab 25mg Odt","code_information":[{"code":"CP17744631829391537","type":"CDM"},{"code":"250","type":"RC"},{"code":"93541","type":"CPT","modifier":"784"}],"standard_charges":[{"setting":"outpatient","modifier_code":["784"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dipyridamole Tab 75mg","code_information":[{"code":"CP17744631829702991","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980013501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Ezetim/simva Tab 10-20mg","code_information":[{"code":"CP17744631829836437","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714077902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-40mg","code_information":[{"code":"CP17744631829836569","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-80mg","code_information":[{"code":"CP17744631829835923","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydroc Iodo  Cre 1%","code_information":[{"code":"CP17744631830091474","type":"CDM"},{"code":"250","type":"RC"},{"code":"52187053201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Inj 1%","code_information":[{"code":"CP17744631830333450","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pantop40mg/100ml","code_information":[{"code":"CP17744631830738050","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pantoprazole 40mg/100ml Ns","code_information":[{"code":"CP17744631830730747","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pantoprazole Inj Sod 40mg","code_information":[{"code":"CP17744631830736813","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830793875","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543045130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830791394","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238161708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Cap 0.5mg","code_information":[{"code":"CP17744631831091710","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Verapamil    Cap 240mg Er","code_information":[{"code":"CP17744631831262890","type":"CDM"},{"code":"250","type":"RC"},{"code":"37864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828519228","type":"CDM"},{"code":"250","type":"RC"},{"code":"78123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Band-aid     Mis Flex Rol","code_information":[{"code":"CP17744631828830591","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137116141","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Band-aid     Mis Kling","code_information":[{"code":"CP17744631828838942","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137116141","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefuroxime   Tab 500mg","code_information":[{"code":"CP17744631829184097","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877021660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Celecoxib    Cap 400mg","code_information":[{"code":"CP17744631829182345","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829210195","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205010491","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clobetasol   Gel 0.05%","code_information":[{"code":"CP17744631829263158","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cyclophosph  Tab 50mg","code_information":[{"code":"CP17744631829448869","type":"CDM"},{"code":"250","type":"RC"},{"code":"10019098401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Darifenacin  Tab 15mg","code_information":[{"code":"CP17744631829542830","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342027707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Darifenacin  Tab 15mg Er","code_information":[{"code":"CP17744631829543355","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342027707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Darifenacin  Tab 7.5mg","code_information":[{"code":"CP17744631829541151","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668020230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Darifenacin  Tab 7.5mg","code_information":[{"code":"CP17744631829542413","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342027607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Darifenacin  Tab 7.5mg","code_information":[{"code":"CP17744631829541179","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700018230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Darifenacin  Tab 7.5mg Er","code_information":[{"code":"CP17744631829549625","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342027607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Dilantin     Chw 50mg","code_information":[{"code":"CP17744631829607128","type":"CDM"},{"code":"250","type":"RC"},{"code":"71000","type":"CPT","modifier":"724"}],"standard_charges":[{"setting":"outpatient","modifier_code":["724"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Erythromycin Oin 5mg/gm","code_information":[{"code":"CP17744631829809405","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478007035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Erythromycin Oin Op","code_information":[{"code":"CP17744631829801164","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478007035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ezetim/simva Tab 10-10mg","code_information":[{"code":"CP17744631829831348","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714077801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-10mg","code_information":[{"code":"CP17744631829834090","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877050790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-20mg","code_information":[{"code":"CP17744631829833274","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462032290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-20mg","code_information":[{"code":"CP17744631829833926","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714077901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-20mg","code_information":[{"code":"CP17744631829830552","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559070130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-20mg","code_information":[{"code":"CP17744631829838510","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462032230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-40mg","code_information":[{"code":"CP17744631829830840","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877050990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-40mg","code_information":[{"code":"CP17744631829831562","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559070230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-40mg","code_information":[{"code":"CP17744631829837461","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-40mg","code_information":[{"code":"CP17744631829836395","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559070290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-80mg","code_information":[{"code":"CP17744631829839231","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559070330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-80mg","code_information":[{"code":"CP17744631829838363","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877051090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetim/simva Tab 10-80mg","code_information":[{"code":"CP17744631829830793","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Felodipine   Tab 5mg Er","code_information":[{"code":"CP17744631829852176","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462023401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ibu/famot    Tab 800-26.6","code_information":[{"code":"CP17744631830122644","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748031209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":800,"type":"EA"}},{"description":"Ibu/famot    Tab 800-26.6","code_information":[{"code":"CP17744631830121259","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877062690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":800,"type":"EA"}},{"description":"Isolation Gowns","code_information":[{"code":"CP17744631830168843","type":"CDM"},{"code":"250","type":"RC"},{"code":"61678421413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Cap 30mg","code_information":[{"code":"CP17744631830446017","type":"CDM"},{"code":"250","type":"RC"},{"code":"52745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Paricalcitol Cap 1 Mcg","code_information":[{"code":"CP17744631830735017","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862093630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Paricalcitol Cap 1 Mcg","code_information":[{"code":"CP17744631830731211","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382033006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Promethazine Inj 25mg/ml","code_information":[{"code":"CP17744631830849245","type":"CDM"},{"code":"250","type":"RC"},{"code":"64114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Promethazine Inj 25mg/ml","code_information":[{"code":"CP17744631830840684","type":"CDM"},{"code":"250","type":"RC"},{"code":"64109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830874480","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241012602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831103561","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571022830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Baclofen     Sol 5mg/5ml","code_information":[{"code":"CP17744631828829834","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888010324","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bd Eclipse   Mis 25gx1\"","code_information":[{"code":"CP17744631828844656","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305837","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cephalexin   Tab 500mg","code_information":[{"code":"CP17744631829194823","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Desvenlafax  Tab 100mg Er","code_information":[{"code":"CP17744631829568267","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Desvenlafax  Tab 25mg Er","code_information":[{"code":"CP17744631829570739","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436003604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Desvenlafax  Tab 50mg Er","code_information":[{"code":"CP17744631829576319","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dexamethason Tab 6mg","code_information":[{"code":"CP17744631829576888","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Doxercalcif  Inj 4mcg/2ml","code_information":[{"code":"CP17744631829735096","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288080203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ezetim/simva Tab 10-20mg","code_information":[{"code":"CP17744631829837975","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598074490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluocinonide 0.1% Cream","code_information":[{"code":"CP17744631829973430","type":"CDM"},{"code":"250","type":"RC"},{"code":"16804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Cap 30mg Er","code_information":[{"code":"CP17744631830440565","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862061101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Repaglinide  Tab 1mg","code_information":[{"code":"CP17744631830882238","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862067101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Spironolacto Sus 25mg/5ml","code_information":[{"code":"CP17744631831061011","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238202708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831099563","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Telmisa/hctz Tab 80-25mg","code_information":[{"code":"CP17744631831102825","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862097803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Accu-chek    Tes Aviva Pl","code_information":[{"code":"CP17744631828170949","type":"CDM"},{"code":"250","type":"RC"},{"code":"65702040710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bengay       Pad Ultra St","code_information":[{"code":"CP17744631828851581","type":"CDM"},{"code":"250","type":"RC"},{"code":"74300008149","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bengay Pn/rel Patch Ult","code_information":[{"code":"CP17744631828852508","type":"CDM"},{"code":"250","type":"RC"},{"code":"7430008149","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clobetasol 'E' 0.05% Foam","code_information":[{"code":"CP17744631829362998","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802063732","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dabigatran   Cap 75mg","code_information":[{"code":"CP17744631829468660","type":"CDM"},{"code":"250","type":"RC"},{"code":"72865027260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Fluocin Acet Oil 0.01%","code_information":[{"code":"CP17744631829969564","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980032920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Furosemide   Inj 10mg/ml","code_information":[{"code":"CP17744631830006640","type":"CDM"},{"code":"250","type":"RC"},{"code":"40916","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Glycopyrrol  Inj 0.2mg/ml","code_information":[{"code":"CP17744631830059184","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714053625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Medrol       Tab 2mg","code_information":[{"code":"CP17744631830403161","type":"CDM"},{"code":"250","type":"RC"},{"code":"90020","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Mesalamine   Cap 400mg Dr","code_information":[{"code":"CP17744631830436301","type":"CDM"},{"code":"250","type":"RC"},{"code":"93590","type":"CPT","modifier":"786"}],"standard_charges":[{"setting":"outpatient","modifier_code":["786"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Slip Tip 3ml Mis","code_information":[{"code":"CP17744631831035850","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290309656","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Amphet/dextr Cap 25mg Er","code_information":[{"code":"CP17744631828514724","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722018901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ivermectin   Lot 0.5%","code_information":[{"code":"CP17744631830175357","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672421108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Magnesium Citrate Oral","code_information":[{"code":"CP17744631830397435","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452039098","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nevirapine   Tab 200mg","code_information":[{"code":"CP17744631830553588","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722050560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pilocarpine  Tab 5mg","code_information":[{"code":"CP17744631830776681","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Salonpas Gel Pad 4%","code_information":[{"code":"CP17744631830992579","type":"CDM"},{"code":"250","type":"RC"},{"code":"46581083006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Telmis+amlod Tb 40/5mg","code_information":[{"code":"CP17744631831103155","type":"CDM"},{"code":"250","type":"RC"},{"code":"37810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ziprasidone  Cap 80mg","code_information":[{"code":"CP17744631831405041","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862070560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ziprasidone  Cap 80mg","code_information":[{"code":"CP17744631831409636","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505253106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ziprasidone 80mg Caps","code_information":[{"code":"CP17744631831403416","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505253106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ziprasidone 80mg Caps","code_information":[{"code":"CP17744631831406205","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862070560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Amphet/dextr Tab 15mg","code_information":[{"code":"CP17744631828512576","type":"CDM"},{"code":"250","type":"RC"},{"code":"52715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Armour Thyro Tab 180mg","code_information":[{"code":"CP17744631828750759","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Atovaquone   Sus 750/5ml","code_information":[{"code":"CP17744631828797070","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452025287","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Battery 2032","code_information":[{"code":"CP17744631828841222","type":"CDM"},{"code":"250","type":"RC"},{"code":"3980008863","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hemmorex-hc  Sup 25mg","code_information":[{"code":"CP17744631830078525","type":"CDM"},{"code":"250","type":"RC"},{"code":"16477020112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830303795","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nevirapine   Tab 200mg","code_information":[{"code":"CP17744631830556906","type":"CDM"},{"code":"250","type":"RC"},{"code":"37840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Nitrostat    Sub 0.4mg","code_information":[{"code":"CP17744631830578251","type":"CDM"},{"code":"250","type":"RC"},{"code":"71041","type":"CPT","modifier":"813"}],"standard_charges":[{"setting":"outpatient","modifier_code":["813"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Noreth/ethin Tab Fe","code_information":[{"code":"CP17744631830579993","type":"CDM"},{"code":"250","type":"RC"},{"code":"37873","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trospium Chl Cap 60mg Er","code_information":[{"code":"CP17744631831198913","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436017404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Trospium Chl Cap 60mg Er","code_information":[{"code":"CP17744631831198189","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010002703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Clotrim/beta Lot Diprop","code_information":[{"code":"CP17744631829383094","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diltiazem Er Tab 180mg","code_information":[{"code":"CP17744631829698211","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Gent 528mg /Ster Water 1000ml","code_information":[{"code":"CP17744631830024160","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":528,"type":"ME"}},{"description":"Genta 40mg/ 100ml Ns Irri","code_information":[{"code":"CP17744631830028406","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Genta 40mg/ Ns Irri 1l","code_information":[{"code":"CP17744631830020277","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Genta 480mg/ns 0.9% Irr 1000ml","code_information":[{"code":"CP17744631830020954","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":480,"type":"ME"}},{"description":"Gentam 100mg In 100ml Ns","code_information":[{"code":"CP17744631830029070","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gentam 100mg/100ml D5w","code_information":[{"code":"CP17744631830029368","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gentam 100mg/100ml Sod Cl 0.9%","code_information":[{"code":"CP17744631830025476","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gentam 120mg/100ml Sod Cl 0.9%","code_information":[{"code":"CP17744631830028697","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Gentam 130mg/100ml Sod Cl 0.9%","code_information":[{"code":"CP17744631830027929","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":130,"type":"ME"}},{"description":"Gentam 150mg In 100ml Ns","code_information":[{"code":"CP17744631830027074","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Gentam 152mg In 100ml Ns","code_information":[{"code":"CP17744631830023801","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":152,"type":"ME"}},{"description":"Gentam 185mg/100ml Ns","code_information":[{"code":"CP17744631830023271","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":185,"type":"ME"}},{"description":"Gentam 60mg/100 Ns","code_information":[{"code":"CP17744631830028684","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Gentam 85mg In 100ml Ns","code_information":[{"code":"CP17744631830028960","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":85,"type":"ME"}},{"description":"Gentamicin   Inj 40mg/ml","code_information":[{"code":"CP17744631830020675","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gentamicin 100mg In 100ml Ns","code_information":[{"code":"CP17744631830027535","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gentamicin 120mg/500ml Sterile","code_information":[{"code":"CP17744631830031777","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Gentamicin 125 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830036346","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Gentamicin 150 Mg/100 Ml Ns","code_information":[{"code":"CP17744631830035424","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Gentamicin 150mg 100ml Nss","code_information":[{"code":"CP17744631830032472","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Gentamicin 20mg/50ml Ns","code_information":[{"code":"CP17744631830038103","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Gentamicin 240mg/1000ml Ns Irr","code_information":[{"code":"CP17744631830037315","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Gentamicin 240mg/500ml Ns Irr.","code_information":[{"code":"CP17744631830032207","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Gentamicin 24mg/50ml Ns","code_information":[{"code":"CP17744631830037607","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Gentamicin 250mg/250ml Ns Irr","code_information":[{"code":"CP17744631830032282","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Gentamicin 40mg/100ml Ns","code_information":[{"code":"CP17744631830037694","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gentamicin 50mg In 100ml Ns","code_information":[{"code":"CP17744631830030033","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Gentamicin 50mg/50mlns","code_information":[{"code":"CP17744631830030572","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Gentamicin 600mg/250ml Ns","code_information":[{"code":"CP17744631830030373","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Gentamicin 60mg / 50ml Ns","code_information":[{"code":"CP17744631830030886","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Gentamicin 60mg/100ml Ns","code_information":[{"code":"CP17744631830034273","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Gentamicin 70mg In 100ml Ns","code_information":[{"code":"CP17744631830034413","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Gentamicin 72mg In 100ml Ns","code_information":[{"code":"CP17744631830030087","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":72,"type":"ME"}},{"description":"Gentamicin 80mg In 100ml Ns","code_information":[{"code":"CP17744631830034915","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Gentamicin 80mg/100ml Ns","code_information":[{"code":"CP17744631830039834","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Gentamicin 8mg In 100ml Ns","code_information":[{"code":"CP17744631830031932","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Gentamicin Inj 40mg/100ml Ns","code_information":[{"code":"CP17744631830037149","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gentamicin/ster Watter","code_information":[{"code":"CP17744631830038987","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentamicin126mg In Nacl 0.9%","code_information":[{"code":"CP17744631830032780","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":126,"type":"ME"}},{"description":"Glycopyrrol  Inj 0.2mg/ml","code_information":[{"code":"CP17744631830052903","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288040703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Isosorb Din  Tab 20mg","code_information":[{"code":"CP17744631830165434","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714000901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Klor-con     Pak 20meq","code_information":[{"code":"CP17744631830199946","type":"CDM"},{"code":"250","type":"RC"},{"code":"24503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacosamide   Tab 50mg","code_information":[{"code":"CP17744631830202480","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462067860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Methylphenid Cap 60mg","code_information":[{"code":"CP17744631830454643","type":"CDM"},{"code":"250","type":"RC"},{"code":"93529","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Methylphenid Tab 54mg Er","code_information":[{"code":"CP17744631830455827","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811070910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":54,"type":"ME"}},{"description":"Methylphenidate La 20mg Cap","code_information":[{"code":"CP17744631830458649","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862061001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830775018","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830772489","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830773121","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729002115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830779811","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237022005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830773226","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237022090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830774465","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237022030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830776826","type":"CDM"},{"code":"250","type":"RC"},{"code":"93727","type":"CPT","modifier":"298"}],"standard_charges":[{"setting":"outpatient","modifier_code":["298"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830778058","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830775410","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830773555","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342005510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830772677","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830777049","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729002116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830799043","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386019430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830793737","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155085676","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830792768","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888002407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830799532","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238161703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830795453","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380087569","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prochlorper  Inj 10mg/2ml","code_information":[{"code":"CP17744631830839242","type":"CDM"},{"code":"250","type":"RC"},{"code":"71303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ziprasidone  Cap 60mg","code_information":[{"code":"CP17744631831401277","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111025860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ziprasidone  Cap 60mg","code_information":[{"code":"CP17744631831404232","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714083701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ziprasidone  Cap 80mg","code_information":[{"code":"CP17744631831407149","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111025960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ziprasidone  Cap 80mg","code_information":[{"code":"CP17744631831401514","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Ziprasidone 60mg Caps","code_information":[{"code":"CP17744631831401140","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Zolpidem Er  Tab 12.5mg","code_information":[{"code":"CP17744631831406908","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Budesonide   Sus 32mcg","code_information":[{"code":"CP17744631828960772","type":"CDM"},{"code":"250","type":"RC"},{"code":"53611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829236770","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Cloraz Dipot Tab 15mg","code_information":[{"code":"CP17744631829382472","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Felbamate    Tab 400mg","code_information":[{"code":"CP17744631829842216","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162073409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Gabapent Dly Er Tab 600mg","code_information":[{"code":"CP17744631830018094","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806065709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Gabapent Dly Tab 300mg","code_information":[{"code":"CP17744631830016951","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806065609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Gabapent Dly Tab 600mg","code_information":[{"code":"CP17744631830019154","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806065709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Gabapentin   Tab 300mg","code_information":[{"code":"CP17744631830014926","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806065609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lidocaine/hc  3-0.5% Top Cream","code_information":[{"code":"CP17744631830336727","type":"CDM"},{"code":"250","type":"RC"},{"code":"59088081903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Mesalamine   Tab 1.2gm","code_information":[{"code":"CP17744631830437414","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722004312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Pantoprazole Inj Sod 40mg","code_information":[{"code":"CP17744631830736730","type":"CDM"},{"code":"250","type":"RC"},{"code":"66794025841","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Verapamil    Cap 120mg Sr","code_information":[{"code":"CP17744631831268179","type":"CDM"},{"code":"250","type":"RC"},{"code":"59128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Accu-chek    Tes Aviva Pl","code_information":[{"code":"CP17744631828174733","type":"CDM"},{"code":"250","type":"RC"},{"code":"65702040810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Allegra-d 24 Hr 180/240mg Tabs","code_information":[{"code":"CP17744631828415251","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167432005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Bd Posiflush Inj 0.9%","code_information":[{"code":"CP17744631828844460","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306545","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Desmopressin Tab 0.2mg","code_information":[{"code":"CP17744631829562821","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462027601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Felbamate    Tab 600mg","code_information":[{"code":"CP17744631829845351","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162073509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829997124","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756060870","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829996216","type":"CDM"},{"code":"250","type":"RC"},{"code":"73289006002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Freestyle    Tes","code_information":[{"code":"CP17744631830000035","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073012050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Sod  Inj 5000/ml","code_information":[{"code":"CP17744631830078933","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739095325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Linezolid    Sus 100/5ml","code_information":[{"code":"CP17744631830347080","type":"CDM"},{"code":"250","type":"RC"},{"code":"54031","type":"CPT","modifier":"950"}],"standard_charges":[{"setting":"outpatient","modifier_code":["950"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Normal Salin Inj 0.9%","code_information":[{"code":"CP17744631830570233","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306545","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Phenytoin Ex Cap 100mg","code_information":[{"code":"CP17744631830765221","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672411101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pioglitazone Tab 30mg","code_information":[{"code":"CP17744631830776600","type":"CDM"},{"code":"250","type":"RC"},{"code":"72606057102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Vancomycin   Sol 250/5ml","code_information":[{"code":"CP17744631831233653","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559083003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Amlod/atorva Tab 10-20mg","code_information":[{"code":"CP17744631828486065","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993027130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bubble Humidifier 350 Ml","code_information":[{"code":"CP17744631828956937","type":"CDM"},{"code":"250","type":"RC"},{"code":"58391","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":350,"type":"ML"}},{"description":"Itraconazole Sol 10mg/ml","code_information":[{"code":"CP17744631830174976","type":"CDM"},{"code":"250","type":"RC"},{"code":"10147015001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pantop40mg/100ml","code_information":[{"code":"CP17744631830735594","type":"CDM"},{"code":"250","type":"RC"},{"code":"70095002403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Perindopril  Tab 4mg","code_information":[{"code":"CP17744631830759500","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862028701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Prednisolone Sus 1% Op","code_information":[{"code":"CP17744631830817941","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758011910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Protonix 40mg/100ml Ns","code_information":[{"code":"CP17744631830858790","type":"CDM"},{"code":"250","type":"RC"},{"code":"70095002403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830875114","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578006514","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830878394","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385096460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830871509","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291077460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830872084","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462032060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830877247","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651001060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine   Tab 1000mg","code_information":[{"code":"CP17744631830874851","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756070460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Ranolazine Er 1000mg Tb12h","code_information":[{"code":"CP17744631830877549","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291077460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Bupropion    Tab 150mg Xl","code_information":[{"code":"CP17744631828980415","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828991158","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Carbidopa    Tab 25mg","code_information":[{"code":"CP17744631829120266","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799012301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Cyclosporine Cap 100mg Md","code_information":[{"code":"CP17744631829449359","type":"CDM"},{"code":"250","type":"RC"},{"code":"93902","type":"CPT","modifier":"65"}],"standard_charges":[{"setting":"outpatient","modifier_code":["65"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dilantin     Cap 30mg","code_information":[{"code":"CP17744631829606923","type":"CDM"},{"code":"250","type":"RC"},{"code":"71374","type":"CPT","modifier":"66"}],"standard_charges":[{"setting":"outpatient","modifier_code":["66"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Dilantin     Cap 30mg","code_information":[{"code":"CP17744631829607209","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151011801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Fluoxetine   Tab 60mg","code_information":[{"code":"CP17744631829975300","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651032430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Fluoxetine   Tab 60mg","code_information":[{"code":"CP17744631829971086","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228042230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Fluoxetine   Tab 60mg","code_information":[{"code":"CP17744631829972840","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180099706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Fluoxetine 60mg Tabs","code_information":[{"code":"CP17744631829971073","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834014830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Guanfacine   Tab 1mg Er","code_information":[{"code":"CP17744631830067012","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Guanfacine   Tab 1mg Er","code_information":[{"code":"CP17744631830061553","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505392701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Guanfacine   Tab 1mg Er","code_information":[{"code":"CP17744631830063886","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332074531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Guanfacine   Tab 2mg Er","code_information":[{"code":"CP17744631830066702","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714019101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Guanfacine   Tab 2mg Er","code_information":[{"code":"CP17744631830064414","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332074631","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Guanfacine   Tab 2mg Er","code_information":[{"code":"CP17744631830067736","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505392801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Guanfacine   Tab 3mg Er","code_information":[{"code":"CP17744631830060108","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714019201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Guanfacine   Tab 3mg Er","code_information":[{"code":"CP17744631830061780","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505392901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Guanfacine   Tab 4mg Er","code_information":[{"code":"CP17744631830067103","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505393001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Guanfacine   Tab 4mg Er","code_information":[{"code":"CP17744631830069483","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332074831","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Guanfacine   Tab 4mg Er","code_information":[{"code":"CP17744631830069842","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304092701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Lubrifresh   Oin P.m.","code_information":[{"code":"CP17744631830384462","type":"CDM"},{"code":"250","type":"RC"},{"code":"90464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methotrexate 25mg/ml Inj","code_information":[{"code":"CP17744631830446816","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323012310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Inj 25mg/ml","code_information":[{"code":"CP17744631830449441","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323012310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pyrazinamide Tab 500mg","code_information":[{"code":"CP17744631830851376","type":"CDM"},{"code":"250","type":"RC"},{"code":"61748001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valproic Acd Sol 250/5ml","code_information":[{"code":"CP17744631831227680","type":"CDM"},{"code":"250","type":"RC"},{"code":"12106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Bupren/nalox 8-2mg Sl Tab","code_information":[{"code":"CP17744631828976178","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756097083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Sub 8-2mg","code_information":[{"code":"CP17744631828979924","type":"CDM"},{"code":"250","type":"RC"},{"code":"40680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Sub 8-2mg","code_information":[{"code":"CP17744631828972078","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162041503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Sub 8-2mg","code_information":[{"code":"CP17744631828976362","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175045832","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Sub 8-2mg","code_information":[{"code":"CP17744631828973240","type":"CDM"},{"code":"250","type":"RC"},{"code":"54018","type":"CPT","modifier":"913"}],"standard_charges":[{"setting":"outpatient","modifier_code":["913"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Sub 8-2mg","code_information":[{"code":"CP17744631828970794","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756097083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Sub 8-2mg Tab","code_information":[{"code":"CP17744631828975129","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175045832","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829218343","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304012201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829215225","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710113101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829218730","type":"CDM"},{"code":"250","type":"RC"},{"code":"83203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829219254","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829219217","type":"CDM"},{"code":"250","type":"RC"},{"code":"52729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829214415","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332073731","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829218887","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462086301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829216624","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238105801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clomipramine Cap 50mg","code_information":[{"code":"CP17744631829379068","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714085003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829431127","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714016525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dexmethylph  Cap 40mg Er","code_information":[{"code":"CP17744631829576360","type":"CDM"},{"code":"250","type":"RC"},{"code":"52781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829720697","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979000406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Donepezil    Tab Hcl 23mg","code_information":[{"code":"CP17744631829724345","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979000406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Dove Bar Soap Sensitive","code_information":[{"code":"CP17744631829720820","type":"CDM"},{"code":"250","type":"RC"},{"code":"1111161120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ethambutol   Tab 400mg","code_information":[{"code":"CP17744631829826284","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806010201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Furosemide   Inj 10mg/ml","code_information":[{"code":"CP17744631830006586","type":"CDM"},{"code":"250","type":"RC"},{"code":"40961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Guaifenesin  Syp Dm","code_information":[{"code":"CP17744631830062743","type":"CDM"},{"code":"250","type":"RC"},{"code":"12112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylpred   Tab 32mg","code_information":[{"code":"CP17744631830451019","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762005101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Methylpred 32mg Tabs","code_information":[{"code":"CP17744631830453020","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762005101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Vaseline Lip Therapy","code_information":[{"code":"CP17744631831252378","type":"CDM"},{"code":"250","type":"RC"},{"code":"52127","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Wixela Inhub Aer 100/50","code_information":[{"code":"CP17744631831373838","type":"CDM"},{"code":"250","type":"RC"},{"code":"37893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Wixela Inhub Aer 100/50 60 Inh","code_information":[{"code":"CP17744631831377136","type":"CDM"},{"code":"250","type":"RC"},{"code":"37893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"3ml Syringe  Mis 22gx1.5\"","code_information":[{"code":"CP17744631828089085","type":"CDM"},{"code":"250","type":"RC"},{"code":"8881833215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"3ml Syringe 22gx1.5\" Safety","code_information":[{"code":"CP17744631828096877","type":"CDM"},{"code":"250","type":"RC"},{"code":"8881833215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Bd Posiflush Inj 0.9%","code_information":[{"code":"CP17744631828845423","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306547","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Caffeine Cit Sol 60mg/3ml","code_information":[{"code":"CP17744631829052153","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335029044","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829263429","type":"CDM"},{"code":"250","type":"RC"},{"code":"70512002860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829260708","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829265665","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700010615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829268210","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672125901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desoximetas  Cre 0.05%","code_information":[{"code":"CP17744631829566976","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexmethylphe Cap 20mg Er","code_information":[{"code":"CP17744631829579365","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714056501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829839027","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877049090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Iv Admin Set / Primary","code_information":[{"code":"CP17744631830179423","type":"CDM"},{"code":"250","type":"RC"},{"code":"28007","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine/hc Cre 3%-0.5%","code_information":[{"code":"CP17744631830336557","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Miglitol     Tab 25mg","code_information":[{"code":"CP17744631830487376","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367030301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Naproxen Dr  Tab 500mg","code_information":[{"code":"CP17744631830548135","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543042610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nasalcease   Mis","code_information":[{"code":"CP17744631830547512","type":"CDM"},{"code":"250","type":"RC"},{"code":"84369000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830677970","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pimecrolimus Cre 1%","code_information":[{"code":"CP17744631830770445","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682011203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831092952","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729042212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thiothixene  Cap 10mg","code_information":[{"code":"CP17744631831128582","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954001710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Triamcinolon Spr 55mcg/ac","code_information":[{"code":"CP17744631831189488","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505627507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":55,"type":"ME"}},{"description":"Azurette     Tab","code_information":[{"code":"CP17744631828810193","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862089006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829833240","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651005230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829836145","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660020005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829836746","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660020030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Flecainide   Tab 50mg","code_information":[{"code":"CP17744631829950538","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746064101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hc Butyrate  Sol 0.1%","code_information":[{"code":"CP17744631830074231","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672406102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Infuvite     Inj Adult","code_information":[{"code":"CP17744631830149390","type":"CDM"},{"code":"250","type":"RC"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Infuvite 10ml In 1000ml Ns","code_information":[{"code":"CP17744631830143504","type":"CDM"},{"code":"250","type":"RC"},{"code":"54643564901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Lidocaine 2% Jelly","code_information":[{"code":"CP17744631830331762","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Tab 36mg Er","code_information":[{"code":"CP17744631830453487","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037072601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":36,"type":"ME"}},{"description":"Polyeth Glyc Pow 3350 Nf","code_information":[{"code":"CP17744631830781805","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784018014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sod Citrate  Sol Citr Acd","code_information":[{"code":"CP17744631831047728","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657031016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trifluoperaz Tab 2mg","code_information":[{"code":"CP17744631831185156","type":"CDM"},{"code":"250","type":"RC"},{"code":"37824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Vilazodone   Tab 10mg","code_information":[{"code":"CP17744631831271021","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205026030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vilazodone   Tab 20mg","code_information":[{"code":"CP17744631831279562","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vilazodone   Tab 40mg","code_information":[{"code":"CP17744631831278350","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603012701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Vilazodone   Tab 40mg","code_information":[{"code":"CP17744631831274647","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205026230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828519341","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722018801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828749324","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061270","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828745740","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756061260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Carbamazepin Cap 100mg Er","code_information":[{"code":"CP17744631829117049","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993040732","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Carbamazepin Cap 200mg Er","code_information":[{"code":"CP17744631829118203","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993040832","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cefaclor     Cap 500mg","code_information":[{"code":"CP17744631829146990","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442017230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829210784","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714004901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Diltiazem Er 360mg Caps","code_information":[{"code":"CP17744631829695307","type":"CDM"},{"code":"250","type":"RC"},{"code":"22829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Fluoxetine   Cap 40mg","code_information":[{"code":"CP17744631829974935","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine   Cap 40mg","code_information":[{"code":"CP17744631829977305","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine Hcl Cap 40mg","code_information":[{"code":"CP17744631829976165","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine Hcl Cap 40mg","code_information":[{"code":"CP17744631829975543","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Haloperidol  Tab 20mg","code_information":[{"code":"CP17744631830066828","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292059001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Hyoscyamine  Sub 0.125mg","code_information":[{"code":"CP17744631830120230","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192033901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Hyoscyamine 0.125mg Subligual","code_information":[{"code":"CP17744631830124135","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192033901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Iv Max Plus Ext Set","code_information":[{"code":"CP17744631830171139","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Klor-con     Pak 20meq","code_information":[{"code":"CP17744631830199982","type":"CDM"},{"code":"250","type":"RC"},{"code":"24503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrig Odt Tab 100mg","code_information":[{"code":"CP17744631830213244","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918037030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lidocaine    Gel 2% Jelly","code_information":[{"code":"CP17744631830332421","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830377760","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547042409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Naftifine    Cre Hcl 2%","code_information":[{"code":"CP17744631830534180","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700016118","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Paxlovid     Tab","code_information":[{"code":"CP17744631830749076","type":"CDM"},{"code":"250","type":"RC"},{"code":"69108","type":"CPT","modifier":"530"}],"standard_charges":[{"setting":"outpatient","modifier_code":["530"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paxlovid     Tab 300-100","code_information":[{"code":"CP17744631830741787","type":"CDM"},{"code":"250","type":"RC"},{"code":"69108","type":"CPT","modifier":"530"}],"standard_charges":[{"setting":"outpatient","modifier_code":["530"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830792021","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386019431","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830791356","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380087570","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rabeprazole  Tab 20mg","code_information":[{"code":"CP17744631830874242","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668010730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rabeprazole  Tab 20mg","code_information":[{"code":"CP17744631830873515","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668010790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sm Calamine  Lot","code_information":[{"code":"CP17744631831031324","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348001134","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tretinoin 0.1% Cream","code_information":[{"code":"CP17744631831179080","type":"CDM"},{"code":"250","type":"RC"},{"code":"57422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amiodarone   Tab 200mg","code_information":[{"code":"CP17744631828471051","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300035905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Amoxapine    Tab 100mg","code_information":[{"code":"CP17744631828502269","type":"CDM"},{"code":"250","type":"RC"},{"code":"59157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828745231","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756027703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828743413","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756027702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828749072","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097016864","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Artificial   Dro Tears","code_information":[{"code":"CP17744631828751784","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896018105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefixime     Sus 200/5ml","code_information":[{"code":"CP17744631829172269","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180040704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Diltiazem    Cap 180mg Er","code_information":[{"code":"CP17744631829695203","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304071990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Diphen/atrop Tab 2.5mg","code_information":[{"code":"CP17744631829701730","type":"CDM"},{"code":"250","type":"RC"},{"code":"71205090930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dronabinol   Cap 2.5mg","code_information":[{"code":"CP17744631829743312","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478076106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829839948","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Floranex     Gra","code_information":[{"code":"CP17744631829964936","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980014612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine/nystatin/zinc Oint","code_information":[{"code":"CP17744631830349096","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565000814","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mesalamine   Tab 1.2gm","code_information":[{"code":"CP17744631830436035","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382071119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Mesalamine   Tab 1.2gm","code_information":[{"code":"CP17744631830434380","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304017513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Mesalamine   Tab 1.2gm","code_information":[{"code":"CP17744631830431341","type":"CDM"},{"code":"250","type":"RC"},{"code":"54092010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Mesalamine Dr 1.2gm Tabs","code_information":[{"code":"CP17744631830431051","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382071119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Mexiletine   Cap 150mg","code_information":[{"code":"CP17744631830472711","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559082001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830678132","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884078611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Probiotic    Cap","code_information":[{"code":"CP17744631830830938","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681008100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venlafaxine  Cap 150mg Er","code_information":[{"code":"CP17744631831251198","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine Er 150mg Cap","code_information":[{"code":"CP17744631831261690","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine Er 150mg Caps","code_information":[{"code":"CP17744631831262945","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Abacavir     Tab 300mg","code_information":[{"code":"CP17744631828103402","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722055760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Abacavir 300mg Tabs","code_information":[{"code":"CP17744631828101336","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862007360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Dianeal Pd-2 Sol 2.5% Dex","code_information":[{"code":"CP17744631829584212","type":"CDM"},{"code":"250","type":"RC"},{"code":"94104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829842341","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578013606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Febuxostat   Tab 40mg","code_information":[{"code":"CP17744631829845766","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205002830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Febuxostat   Tab 80mg","code_information":[{"code":"CP17744631829848051","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205002930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Febuxostat   Tab 80mg","code_information":[{"code":"CP17744631829842208","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578013706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Gavilyte-c   Sol","code_information":[{"code":"CP17744631830023288","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386006019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gavilyte-n   Sol Flav Pk","code_information":[{"code":"CP17744631830028528","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386005019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glycopyrrol  Inj 1mg/5ml","code_information":[{"code":"CP17744631830057893","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700016725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Montelukast  Tab 10mg","code_information":[{"code":"CP17744631830501178","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Morphine Sul Tab 15mg Er","code_information":[{"code":"CP17744631830504579","type":"CDM"},{"code":"250","type":"RC"},{"code":"40683","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Nulytely     Sol Lmn/lime","code_information":[{"code":"CP17744631830641702","type":"CDM"},{"code":"250","type":"RC"},{"code":"52268030201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paxlovid     Tab 150-100","code_information":[{"code":"CP17744631830746702","type":"CDM"},{"code":"250","type":"RC"},{"code":"69110","type":"CPT","modifier":"120"}],"standard_charges":[{"setting":"outpatient","modifier_code":["120"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Paxlovid 150-100 Tbpk","code_information":[{"code":"CP17744631830748086","type":"CDM"},{"code":"250","type":"RC"},{"code":"69110","type":"CPT","modifier":"120"}],"standard_charges":[{"setting":"outpatient","modifier_code":["120"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Precision    Tes Xtra","code_information":[{"code":"CP17744631830819787","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599972804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ritonavir    Tab 100mg","code_information":[{"code":"CP17744631830903229","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722059730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"10ml Ll Syrn Mis 20gx1","code_information":[{"code":"CP17744631828063741","type":"CDM"},{"code":"250","type":"RC"},{"code":"10318","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"1ml 25gx1\" Safety Syr Ndl","code_information":[{"code":"CP17744631828078751","type":"CDM"},{"code":"250","type":"RC"},{"code":"47859","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"1ml Syringe","code_information":[{"code":"CP17744631828072730","type":"CDM"},{"code":"250","type":"RC"},{"code":"17191008101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"4-n-1        Cre","code_information":[{"code":"CP17744631828096960","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924020804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"A & D Ointment","code_information":[{"code":"CP17744631828099096","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385007026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acidophilus/ Tab Cit Pect","code_information":[{"code":"CP17744631828315930","type":"CDM"},{"code":"250","type":"RC"},{"code":"53671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Oin 5%","code_information":[{"code":"CP17744631828336275","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Adapalene 0.1% Gel","code_information":[{"code":"CP17744631828344222","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462040355","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adlt Barrier Aer 10%","code_information":[{"code":"CP17744631828359872","type":"CDM"},{"code":"250","type":"RC"},{"code":"17803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Afluria Quad Inj 2020-21","code_information":[{"code":"CP17744631828361711","type":"CDM"},{"code":"250","type":"RC"},{"code":"33332042010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2020,"type":"EA"}},{"description":"Alavert      Tab 10mg","code_information":[{"code":"CP17744631828371321","type":"CDM"},{"code":"250","type":"RC"},{"code":"57326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Alavert      Tab 10mg","code_information":[{"code":"CP17744631828377295","type":"CDM"},{"code":"250","type":"RC"},{"code":"57326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Albuterol    Neb 0.083%","code_information":[{"code":"CP17744631828376148","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Albuterol 0.083% Nebu","code_information":[{"code":"CP17744631828390671","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":83,"type":"EA"}},{"description":"Allergy Relf Tab 4mg","code_information":[{"code":"CP17744631828412372","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896078401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Amlod/benazp Cap 5-40mg","code_information":[{"code":"CP17744631828483203","type":"CDM"},{"code":"250","type":"RC"},{"code":"78122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/valsar Tab /Hctz","code_information":[{"code":"CP17744631828483593","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180077106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/valsar Tab /Hctz","code_information":[{"code":"CP17744631828480075","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180077506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ammonia Inhalant Pouches","code_information":[{"code":"CP17744631828494519","type":"CDM"},{"code":"250","type":"RC"},{"code":"10000000033","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amox/k Clav  Sus 250/5ml","code_information":[{"code":"CP17744631828509223","type":"CDM"},{"code":"250","type":"RC"},{"code":"72508020415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Amox/k Clav  Sus 250/5ml","code_information":[{"code":"CP17744631828500729","type":"CDM"},{"code":"250","type":"RC"},{"code":"72508020407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Anacin       Tab 400-32mg","code_information":[{"code":"CP17744631828534047","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736020025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Anbesol      Gel 10%","code_information":[{"code":"CP17744631828534031","type":"CDM"},{"code":"250","type":"RC"},{"code":"57302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Anbesol      Gel 20%","code_information":[{"code":"CP17744631828533350","type":"CDM"},{"code":"250","type":"RC"},{"code":"57302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Anbesol      Liq 10%","code_information":[{"code":"CP17744631828534586","type":"CDM"},{"code":"250","type":"RC"},{"code":"57302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Anbesol      Liq 20%","code_information":[{"code":"CP17744631828531584","type":"CDM"},{"code":"250","type":"RC"},{"code":"57302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Anbesol  20% Gel","code_information":[{"code":"CP17744631828533579","type":"CDM"},{"code":"250","type":"RC"},{"code":"57302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Anbesol 10% Gel","code_information":[{"code":"CP17744631828534466","type":"CDM"},{"code":"250","type":"RC"},{"code":"57302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Antacid      Sus Reg St","code_information":[{"code":"CP17744631828536977","type":"CDM"},{"code":"250","type":"RC"},{"code":"37205031440","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti-fungal  Pow 1%","code_information":[{"code":"CP17744631828725266","type":"CDM"},{"code":"250","type":"RC"},{"code":"53651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anti-itch    Cre 20-3%","code_information":[{"code":"CP17744631828720933","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000036901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Asa/dipyrida Cap 25-200mg","code_information":[{"code":"CP17744631828752422","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436009205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Aspir-81     Tab 81mg Ec","code_information":[{"code":"CP17744631828761112","type":"CDM"},{"code":"250","type":"RC"},{"code":"62107002732","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Aspirin 81mg Ec Tabs","code_information":[{"code":"CP17744631828765602","type":"CDM"},{"code":"250","type":"RC"},{"code":"62107002732","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Atenolol     Tab 50mg","code_information":[{"code":"CP17744631828775612","type":"CDM"},{"code":"250","type":"RC"},{"code":"78115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Atenolol 2mg/ml","code_information":[{"code":"CP17744631828774163","type":"CDM"},{"code":"250","type":"RC"},{"code":"78115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Atenolol 50mg Tabs","code_information":[{"code":"CP17744631828777260","type":"CDM"},{"code":"250","type":"RC"},{"code":"78115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Aubagio      Tab 14mg","code_information":[{"code":"CP17744631828795381","type":"CDM"},{"code":"250","type":"RC"},{"code":"58468021002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Autoshield   Mis 29x3/16\"","code_information":[{"code":"CP17744631828798844","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290329305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aveeno Baby  Liq Wash","code_information":[{"code":"CP17744631828796695","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137004249","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aveeno Soothing Relief Creamy","code_information":[{"code":"CP17744631828804237","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137102394","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelaic Acid Gel 15%","code_information":[{"code":"CP17744631828804329","type":"CDM"},{"code":"250","type":"RC"},{"code":"59121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Azelaic Acid Gel 15%","code_information":[{"code":"CP17744631828804140","type":"CDM"},{"code":"250","type":"RC"},{"code":"11516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Azithromycin Inj 500mg","code_information":[{"code":"CP17744631828810808","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457086050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828812920","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762306001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Benzoyl Per  Liq 6%","code_information":[{"code":"CP17744631828865492","type":"CDM"},{"code":"250","type":"RC"},{"code":"67405083506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Bidil        Tab","code_information":[{"code":"CP17744631828876190","type":"CDM"},{"code":"250","type":"RC"},{"code":"24338001018","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bisacodyl    Sup 10mg","code_information":[{"code":"CP17744631828921272","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bisacodyl    Sup 10mg","code_information":[{"code":"CP17744631828929180","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896044405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bisacodyl    Sup 10mg","code_information":[{"code":"CP17744631828927562","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bismatrol    Sus 262/15ml","code_information":[{"code":"CP17744631828935168","type":"CDM"},{"code":"250","type":"RC"},{"code":"90413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Bismatrol    Sus 525/15ml","code_information":[{"code":"CP17744631828930874","type":"CDM"},{"code":"250","type":"RC"},{"code":"90413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Bismuth/diphenhydramine","code_information":[{"code":"CP17744631828937326","type":"CDM"},{"code":"250","type":"RC"},{"code":"90413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bordered     Pad 4\"x4\"","code_information":[{"code":"CP17744631828943308","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924025544","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bordered     Pad 6\"x6\"","code_information":[{"code":"CP17744631828941494","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924025666","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupren/nalox Mis 12-3mg","code_information":[{"code":"CP17744631828978862","type":"CDM"},{"code":"250","type":"RC"},{"code":"78172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Bupren/nalox Mis 8-2mg","code_information":[{"code":"CP17744631828971287","type":"CDM"},{"code":"250","type":"RC"},{"code":"78172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Buprenph/nalox 2/0.5mg Film","code_information":[{"code":"CP17744631828986542","type":"CDM"},{"code":"250","type":"RC"},{"code":"78172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Bupropion    Tab 75mg","code_information":[{"code":"CP17744631828999539","type":"CDM"},{"code":"250","type":"RC"},{"code":"37804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Bydureon Pen Inj 2mg","code_information":[{"code":"CP17744631829045601","type":"CDM"},{"code":"250","type":"RC"},{"code":"31065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Ca Cit/vit D Tab 315/200","code_information":[{"code":"CP17744631829058221","type":"CDM"},{"code":"250","type":"RC"},{"code":"10006070044","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":315,"type":"EA"}},{"description":"Calazime Skn Pst Protect","code_information":[{"code":"CP17744631829054639","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329016544","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcip/betam Sus","code_information":[{"code":"CP17744631829063022","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672140204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcitrate   Tab 950mg","code_information":[{"code":"CP17744631829065781","type":"CDM"},{"code":"250","type":"RC"},{"code":"90450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":950,"type":"ME"}},{"description":"Calcitrate 200mg Tab","code_information":[{"code":"CP17744631829063199","type":"CDM"},{"code":"250","type":"RC"},{"code":"90450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Calcitriol   Cap 0.25mcg","code_information":[{"code":"CP17744631829066798","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155011801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Calcitriol   Cap 0.5mcg","code_information":[{"code":"CP17744631829063981","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155011901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Calcitriol 0.25mcg Caps","code_information":[{"code":"CP17744631829066341","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155011801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Calcium Citrate 200mg Tabs","code_information":[{"code":"CP17744631829081005","type":"CDM"},{"code":"250","type":"RC"},{"code":"90450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Calcium/vit D 315/200mg Tabs","code_information":[{"code":"CP17744631829095687","type":"CDM"},{"code":"250","type":"RC"},{"code":"10006070044","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":315,"type":"ME"}},{"description":"Callus Remov Pad 40%","code_information":[{"code":"CP17744631829097604","type":"CDM"},{"code":"250","type":"RC"},{"code":"11017040966","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Campho-pheni Gel","code_information":[{"code":"CP17744631829090326","type":"CDM"},{"code":"250","type":"RC"},{"code":"24021","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carb/levo    Tab 10-100mg","code_information":[{"code":"CP17744631829104825","type":"CDM"},{"code":"250","type":"RC"},{"code":"22825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Carb/levo    Tab 25-100mg","code_information":[{"code":"CP17744631829100651","type":"CDM"},{"code":"250","type":"RC"},{"code":"37850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo    Tab 25-100mg","code_information":[{"code":"CP17744631829102318","type":"CDM"},{"code":"250","type":"RC"},{"code":"22825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo 25-100mg Odt","code_information":[{"code":"CP17744631829106354","type":"CDM"},{"code":"250","type":"RC"},{"code":"37850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo 25-100mg Tabs","code_information":[{"code":"CP17744631829117418","type":"CDM"},{"code":"250","type":"RC"},{"code":"22825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo Odt 25-100mg","code_information":[{"code":"CP17744631829118004","type":"CDM"},{"code":"250","type":"RC"},{"code":"37850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carbidopa    Tab 25mg","code_information":[{"code":"CP17744631829127708","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386098001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Cefixime     Sus 100/5ml","code_information":[{"code":"CP17744631829178637","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862075150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Cetaklenz    Liq","code_information":[{"code":"CP17744631829207609","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cetirizine   Chw 10mg","code_information":[{"code":"CP17744631829200878","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746028632","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chalet Cream","code_information":[{"code":"CP17744631829204132","type":"CDM"},{"code":"250","type":"RC"},{"code":"53657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chantix      Pak 0.5& 1mg","code_information":[{"code":"CP17744631829201153","type":"CDM"},{"code":"250","type":"RC"},{"code":"69047","type":"CPT","modifier":"103"}],"standard_charges":[{"setting":"outpatient","modifier_code":["103"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Chantix      Pak 1mg","code_information":[{"code":"CP17744631829202184","type":"CDM"},{"code":"250","type":"RC"},{"code":"69046","type":"CPT","modifier":"903"}],"standard_charges":[{"setting":"outpatient","modifier_code":["903"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Chlorthalid  Tab 25mg","code_information":[{"code":"CP17744631829227023","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689034599","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorthalid  Tab 50mg","code_information":[{"code":"CP17744631829223094","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689034699","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Chlorzoxazon Tab 750mg","code_information":[{"code":"CP17744631829227294","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829227202","type":"CDM"},{"code":"250","type":"RC"},{"code":"24505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Ciloxan      Oin 0.3% Op","code_information":[{"code":"CP17744631829226051","type":"CDM"},{"code":"250","type":"RC"},{"code":"65065","type":"CPT","modifier":"435"}],"standard_charges":[{"setting":"outpatient","modifier_code":["435"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Cinnamon     Cap 500mg","code_information":[{"code":"CP17744631829231521","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295012773","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829235013","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571012025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Clear Away   Pad Plantar","code_information":[{"code":"CP17744631829240705","type":"CDM"},{"code":"250","type":"RC"},{"code":"11017011001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clindamy/ben Gel 1-5%","code_information":[{"code":"CP17744631829258959","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682019025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clindamycin  Cap 150mg","code_information":[{"code":"CP17744631829255840","type":"CDM"},{"code":"250","type":"RC"},{"code":"59157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Clindamycin  Cap 300mg","code_information":[{"code":"CP17744631829252411","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829265972","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Sol 0.05%","code_information":[{"code":"CP17744631829364661","type":"CDM"},{"code":"250","type":"RC"},{"code":"47204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clomipramine Cap 25mg","code_information":[{"code":"CP17744631829374478","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clozapine    Tab 150/odt","code_information":[{"code":"CP17744631829393256","type":"CDM"},{"code":"250","type":"RC"},{"code":"93308","type":"CPT","modifier":"684"}],"standard_charges":[{"setting":"outpatient","modifier_code":["684"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Crestor      Tab 40mg","code_information":[{"code":"CP17744631829438038","type":"CDM"},{"code":"250","type":"RC"},{"code":"31007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Crestor 20mg Tabs","code_information":[{"code":"CP17744631829439223","type":"CDM"},{"code":"250","type":"RC"},{"code":"31007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Cyclobenzapr Tab 7.5mg","code_information":[{"code":"CP17744631829434637","type":"CDM"},{"code":"250","type":"RC"},{"code":"59133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cymbalta     Cap 60mg","code_information":[{"code":"CP17744631829449370","type":"CDM"},{"code":"250","type":"RC"},{"code":"23270","type":"CPT","modifier":"4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["4"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cyproheptad  Syp 2mg/5ml","code_information":[{"code":"CP17744631829441445","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689033316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dapsone      Tab 100mg","code_information":[{"code":"CP17744631829477370","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925050530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dapsone      Tab 25mg","code_information":[{"code":"CP17744631829476899","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925050430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Depakote     Tab 250mg Dr","code_information":[{"code":"CP17744631829553309","type":"CDM"},{"code":"250","type":"RC"},{"code":"74621","type":"CPT","modifier":"453"}],"standard_charges":[{"setting":"outpatient","modifier_code":["453"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Dermacerin   Cre","code_information":[{"code":"CP17744631829552793","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924017804","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dermafungal 2%","code_information":[{"code":"CP17744631829553261","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924023404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dermamed     Oin","code_information":[{"code":"CP17744631829551495","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924021404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dermaphor    Oin","code_information":[{"code":"CP17744631829558449","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924018416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desonide     Oin 0.05%","code_information":[{"code":"CP17744631829560362","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexmethylphe Cap 10mg Er","code_information":[{"code":"CP17744631829571002","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714056301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diabetic Tus Liq Max St","code_information":[{"code":"CP17744631829580861","type":"CDM"},{"code":"250","type":"RC"},{"code":"61787006404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diabetic Tussin Dm 200-10mg/5","code_information":[{"code":"CP17744631829582557","type":"CDM"},{"code":"250","type":"RC"},{"code":"61787006404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Diabetic Tussin Maximum","code_information":[{"code":"CP17744631829582880","type":"CDM"},{"code":"250","type":"RC"},{"code":"61787006404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dicyclomine  Tab 20mg","code_information":[{"code":"CP17744631829591599","type":"CDM"},{"code":"250","type":"RC"},{"code":"37816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Dicyclomine 20mg Tabs","code_information":[{"code":"CP17744631829606797","type":"CDM"},{"code":"250","type":"RC"},{"code":"37816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Diflunisal   Tab 500mg","code_information":[{"code":"CP17744631829603328","type":"CDM"},{"code":"250","type":"RC"},{"code":"93075","type":"CPT","modifier":"506"}],"standard_charges":[{"setting":"outpatient","modifier_code":["506"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Diltiazem    Tab 60mg","code_information":[{"code":"CP17744631829698349","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dimetapp     Liq Nighttim","code_information":[{"code":"CP17744631829707582","type":"CDM"},{"code":"250","type":"RC"},{"code":"31224","type":"CPT","modifier":"713"}],"standard_charges":[{"setting":"outpatient","modifier_code":["713"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dimetapp Cld Elx /Allergy","code_information":[{"code":"CP17744631829706902","type":"CDM"},{"code":"250","type":"RC"},{"code":"31223","type":"CPT","modifier":"513"}],"standard_charges":[{"setting":"outpatient","modifier_code":["513"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dimetapp Cld Elx /Allergy","code_information":[{"code":"CP17744631829705097","type":"CDM"},{"code":"250","type":"RC"},{"code":"31223","type":"CPT","modifier":"519"}],"standard_charges":[{"setting":"outpatient","modifier_code":["519"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diphenhydram Cap 25mg","code_information":[{"code":"CP17744631829700071","type":"CDM"},{"code":"250","type":"RC"},{"code":"18506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diphenhydram Cap 50mg","code_information":[{"code":"CP17744631829708594","type":"CDM"},{"code":"250","type":"RC"},{"code":"18506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Docusate     Cap 100mg","code_information":[{"code":"CP17744631829717549","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399802001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Docusate 100mg Caps","code_information":[{"code":"CP17744631829715045","type":"CDM"},{"code":"250","type":"RC"},{"code":"90464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dok          Cap 100mg","code_information":[{"code":"CP17744631829726237","type":"CDM"},{"code":"250","type":"RC"},{"code":"90464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Donepezil    Tab 10mg Odt","code_information":[{"code":"CP17744631829725040","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382034706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Double Antib Oin","code_information":[{"code":"CP17744631829721976","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dovonex      Cre 0.005%","code_information":[{"code":"CP17744631829729479","type":"CDM"},{"code":"250","type":"RC"},{"code":"50222026012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Doxycycl Hyc Cap 100mg","code_information":[{"code":"CP17744631829741119","type":"CDM"},{"code":"250","type":"RC"},{"code":"67405065105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline  Sus 25mg/5ml","code_information":[{"code":"CP17744631829746348","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097022843","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Doxycycline Hyc 100mg Caps","code_information":[{"code":"CP17744631829741177","type":"CDM"},{"code":"250","type":"RC"},{"code":"67405065155","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dr Smiths    Oin Diaper","code_information":[{"code":"CP17744631829749181","type":"CDM"},{"code":"250","type":"RC"},{"code":"17803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dronabinol   Cap 10mg","code_information":[{"code":"CP17744631829749460","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877057060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dronabinol   Cap 2.5mg","code_information":[{"code":"CP17744631829744446","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877056860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dronabinol   Cap 5mg","code_information":[{"code":"CP17744631829741430","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877056960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Duloxetine   Cap 20mg","code_information":[{"code":"CP17744631829759521","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241009706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Duloxetine   Cap 20mg","code_information":[{"code":"CP17744631829751161","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335038186","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829754149","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335038281","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine   Cap 60mg","code_information":[{"code":"CP17744631829756101","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335038318","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Enalapr/hctz Tab 10-25mg","code_information":[{"code":"CP17744631829770686","type":"CDM"},{"code":"250","type":"RC"},{"code":"37807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Enoxaparin   Inj 100mg/ml","code_information":[{"code":"CP17744631829781253","type":"CDM"},{"code":"250","type":"RC"},{"code":"70385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enoxaparin   Inj 120/0.8","code_information":[{"code":"CP17744631829783605","type":"CDM"},{"code":"250","type":"RC"},{"code":"70386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Enoxaparin   Inj 40/0.4ml","code_information":[{"code":"CP17744631829789666","type":"CDM"},{"code":"250","type":"RC"},{"code":"70385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Enoxaparin 40mg/0.4 Ml Dose","code_information":[{"code":"CP17744631829781057","type":"CDM"},{"code":"250","type":"RC"},{"code":"70385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829815306","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829816915","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829815354","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomeprazole 40mg Caps","code_information":[{"code":"CP17744631829811074","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Eucerin Calm Lot 0.1%","code_information":[{"code":"CP17744631829820950","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140063647","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Evencare G2  Tes","code_information":[{"code":"CP17744631829820306","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327006109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eye Itch Rel Dro 0.025%op","code_information":[{"code":"CP17744631829836440","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000012401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Farydak      Cap 15mg","code_information":[{"code":"CP17744631829845777","type":"CDM"},{"code":"250","type":"RC"},{"code":"78065","type":"CPT","modifier":"106"}],"standard_charges":[{"setting":"outpatient","modifier_code":["106"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Felbamate    Tab 400mg","code_information":[{"code":"CP17744631829842706","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162073403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Fenofibrate  Cap 200mg","code_information":[{"code":"CP17744631829851462","type":"CDM"},{"code":"250","type":"RC"},{"code":"11505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fenofibrate  Cap 200mg","code_information":[{"code":"CP17744631829855378","type":"CDM"},{"code":"250","type":"RC"},{"code":"37886","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fenofibrate  Tab 48mg","code_information":[{"code":"CP17744631829850236","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":48,"type":"ME"}},{"description":"Fenofibrate 145mg Tabs","code_information":[{"code":"CP17744631829854993","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Fenofibric   Cap 135mg Dr","code_information":[{"code":"CP17744631829856618","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382023316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":135,"type":"ME"}},{"description":"Fentanyl     Dis 25mcg/hr","code_information":[{"code":"CP17744631829856993","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505700602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fentanyl     Dis 50mcg/hr","code_information":[{"code":"CP17744631829855428","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505700702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ferosul      Tab 325mg","code_information":[{"code":"CP17744631829861964","type":"CDM"},{"code":"250","type":"RC"},{"code":"90475","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Ferrous Sulf Tab 325mg Ec","code_information":[{"code":"CP17744631829863314","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681007901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Fexofenadine Tab 60mg","code_information":[{"code":"CP17744631829941833","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Fexofenadine Tab 60mg","code_information":[{"code":"CP17744631829947406","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802042578","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Fiber Therapy Powder","code_information":[{"code":"CP17744631829956718","type":"CDM"},{"code":"250","type":"RC"},{"code":"10006070171","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Film Buprenph/nalox 4/1mg","code_information":[{"code":"CP17744631829957145","type":"CDM"},{"code":"250","type":"RC"},{"code":"78172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"First-omepra Sus 2mg/ml","code_information":[{"code":"CP17744631829950526","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628007003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Flecainide   Tab 100mg","code_information":[{"code":"CP17744631829956270","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162064210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fleet Bisaco Ene 10/30ml","code_information":[{"code":"CP17744631829959328","type":"CDM"},{"code":"250","type":"RC"},{"code":"13207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Flexall Pain Gel Relievng","code_information":[{"code":"CP17744631829956090","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167016013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flomax       Cap 0.4mg","code_information":[{"code":"CP17744631829952357","type":"CDM"},{"code":"250","type":"RC"},{"code":"59700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Flovent Disk Aer 250mcg","code_information":[{"code":"CP17744631829962215","type":"CDM"},{"code":"250","type":"RC"},{"code":"17306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluarix Quad Inj 2020-21","code_information":[{"code":"CP17744631829964704","type":"CDM"},{"code":"250","type":"RC"},{"code":"58160088552","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2020,"type":"EA"}},{"description":"Fluconazole 100mg/ml","code_information":[{"code":"CP17744631829969965","type":"CDM"},{"code":"250","type":"RC"},{"code":"17254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluocin Acet Sol 0.01%","code_information":[{"code":"CP17744631829974460","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluoxetine   Tab 10mg","code_information":[{"code":"CP17744631829972573","type":"CDM"},{"code":"250","type":"RC"},{"code":"37807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluticasone Nasl Spr 0.05%","code_information":[{"code":"CP17744631829982678","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011026902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluzone Hd   Inj Pf 20-21","code_information":[{"code":"CP17744631829996510","type":"CDM"},{"code":"250","type":"RC"},{"code":"49281012065","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Fungicure    Liq 25%","code_information":[{"code":"CP17744631830002653","type":"CDM"},{"code":"250","type":"RC"},{"code":"72959061030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Furosemide   Tab 80mg","code_information":[{"code":"CP17744631830000333","type":"CDM"},{"code":"250","type":"RC"},{"code":"37802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Gabapentin   Sol 300/6ml","code_information":[{"code":"CP17744631830011625","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383031109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ML"}},{"description":"Galantamine  Cap 24mg Er","code_information":[{"code":"CP17744631830010138","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862074630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Galantamine  Cap 8mg Er","code_information":[{"code":"CP17744631830016889","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862074430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Galantamine  Tab 8mg","code_information":[{"code":"CP17744631830026931","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505254306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Gas Relief   Dro 20/0.3ml","code_information":[{"code":"CP17744631830021191","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Gatifloxacin Sol 0.5%","code_information":[{"code":"CP17744631830020958","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180043501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Gelrite      Liq Sanitize","code_information":[{"code":"CP17744631830028631","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924010616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gelrite      Liq Sanitize","code_information":[{"code":"CP17744631830028104","type":"CDM"},{"code":"250","type":"RC"},{"code":"61924010604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Genteal Severe 0.3% Gel","code_information":[{"code":"CP17744631830038212","type":"CDM"},{"code":"250","type":"RC"},{"code":"78042","type":"CPT","modifier":"947"}],"standard_charges":[{"setting":"outpatient","modifier_code":["947"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Genteal Tear Sol Mild","code_information":[{"code":"CP17744631830031506","type":"CDM"},{"code":"250","type":"RC"},{"code":"65041","type":"CPT","modifier":"881"}],"standard_charges":[{"setting":"outpatient","modifier_code":["881"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Genteal Tear Sol Mild","code_information":[{"code":"CP17744631830034951","type":"CDM"},{"code":"250","type":"RC"},{"code":"65041","type":"CPT","modifier":"880"}],"standard_charges":[{"setting":"outpatient","modifier_code":["880"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentle Skin Cleanser","code_information":[{"code":"CP17744631830037181","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Geri-kot     Tab 8.6mg","code_information":[{"code":"CP17744631830037708","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896045101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":86,"type":"ME"}},{"description":"Glucos/chond Cap 500-400","code_information":[{"code":"CP17744631830044798","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681011700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Glucos/chond Cap 500-400","code_information":[{"code":"CP17744631830042185","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896085906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Gnp Vit A&d  Oin","code_information":[{"code":"CP17744631830056767","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385007026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gold Bond    Aer Powder","code_information":[{"code":"CP17744631830058906","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167001310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gold Bond    Pow Foot Ms","code_information":[{"code":"CP17744631830052271","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167001704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gold Bond    Pow Foot Ms","code_information":[{"code":"CP17744631830054619","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167001710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gold Bond Max/str Powder","code_information":[{"code":"CP17744631830059907","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167001704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gold Bond X/str Powder","code_information":[{"code":"CP17744631830059347","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167004040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Guanfacine 1mg Tabs","code_information":[{"code":"CP17744631830066959","type":"CDM"},{"code":"250","type":"RC"},{"code":"37811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Hc Butyrate  Cre 0.1%","code_information":[{"code":"CP17744631830074823","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682027045","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Lock Inj 100/ml","code_information":[{"code":"CP17744631830070165","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807060512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Heparin Lock Inj 10unt/ml","code_information":[{"code":"CP17744631830077107","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807050005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Heparin Lock Inj 10unt/ml","code_information":[{"code":"CP17744631830078086","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807050050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Hm Tussin    Liq Dm Max","code_information":[{"code":"CP17744631830081298","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011021101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort    Tab 10mg","code_information":[{"code":"CP17744631830104126","type":"CDM"},{"code":"250","type":"RC"},{"code":"42543014101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydrocort    Tab 20mg","code_information":[{"code":"CP17744631830108028","type":"CDM"},{"code":"250","type":"RC"},{"code":"42543014201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Hydrocort/iodoquinol 1-1% Crm","code_information":[{"code":"CP17744631830114057","type":"CDM"},{"code":"250","type":"RC"},{"code":"58980081110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocortisone 1% Crm","code_information":[{"code":"CP17744631830111107","type":"CDM"},{"code":"250","type":"RC"},{"code":"90476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocortisone 5mg Tabs","code_information":[{"code":"CP17744631830112064","type":"CDM"},{"code":"250","type":"RC"},{"code":"42543014050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydrocortisone/aloe 1% Crm","code_information":[{"code":"CP17744631830119034","type":"CDM"},{"code":"250","type":"RC"},{"code":"90476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroxyz Pam Cap 50mg","code_information":[{"code":"CP17744631830123104","type":"CDM"},{"code":"250","type":"RC"},{"code":"18506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hydroxyz Pam Cap 50mg","code_information":[{"code":"CP17744631830129470","type":"CDM"},{"code":"250","type":"RC"},{"code":"18506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hyoscyamine  Dro 0.125/ml","code_information":[{"code":"CP17744631830122134","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657042815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Icy Hot      Gel Power","code_information":[{"code":"CP17744631830136018","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167000860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ilevro       Dro 0.3% Op","code_information":[{"code":"CP17744631830130885","type":"CDM"},{"code":"250","type":"RC"},{"code":"65175","type":"CPT","modifier":"14"}],"standard_charges":[{"setting":"outpatient","modifier_code":["14"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Indomethacin Cap 50mg","code_information":[{"code":"CP17744631830138223","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382029401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Insulin Syrg Mis 1ml","code_information":[{"code":"CP17744631830147826","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290329654","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Insulin Syrg Mis 1ml/25g","code_information":[{"code":"CP17744631830149893","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290329622","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Ipratropium  Sol 0.02%inh","code_information":[{"code":"CP17744631830150553","type":"CDM"},{"code":"250","type":"RC"},{"code":"59137","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Isopto Carp  Sol 4% Op","code_information":[{"code":"CP17744631830164730","type":"CDM"},{"code":"250","type":"RC"},{"code":"99802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Isradipine   Cap 2.5mg","code_information":[{"code":"CP17744631830169228","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462080701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Isradipine   Cap 5mg","code_information":[{"code":"CP17744631830161362","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462080801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Iv Dressing Chang","code_information":[{"code":"CP17744631830178767","type":"CDM"},{"code":"250","type":"RC"},{"code":"11399","type":"CPT","modifier":"19"}],"standard_charges":[{"setting":"outpatient","modifier_code":["19"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Ultrasite Valve","code_information":[{"code":"CP17744631830171854","type":"CDM"},{"code":"250","type":"RC"},{"code":"41511","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketotifen Fumarate 0.025% Opth","code_information":[{"code":"CP17744631830196723","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000012401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Klor-con 10  Tab 10meq Er","code_information":[{"code":"CP17744631830190601","type":"CDM"},{"code":"250","type":"RC"},{"code":"66758016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Konsyl Daily Pow 100%","code_information":[{"code":"CP17744631830195601","type":"CDM"},{"code":"250","type":"RC"},{"code":"22418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Konsyl Daily Pow 100%","code_information":[{"code":"CP17744631830197080","type":"CDM"},{"code":"250","type":"RC"},{"code":"22418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Labetalol    Tab 300mg","code_information":[{"code":"CP17744631830206097","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657060701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lastacaft    Sol 0.25%","code_information":[{"code":"CP17744631830229127","type":"CDM"},{"code":"250","type":"RC"},{"code":"23429","type":"CPT","modifier":"3"}],"standard_charges":[{"setting":"outpatient","modifier_code":["3"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"L-carnitine  Cap 250mg","code_information":[{"code":"CP17744631830224448","type":"CDM"},{"code":"250","type":"RC"},{"code":"10006073026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 500mg","code_information":[{"code":"CP17744631830310419","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382001618","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levothyroxin Tab 100mcg","code_information":[{"code":"CP17744631830313118","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxin Tab 100mcg","code_information":[{"code":"CP17744631830317881","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxin Tab 125mcg","code_information":[{"code":"CP17744631830317774","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Levothyroxin Tab 137mcg","code_information":[{"code":"CP17744631830313653","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Levothyroxin Tab 200mcg","code_information":[{"code":"CP17744631830313078","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Levothyroxin Tab 25mcg","code_information":[{"code":"CP17744631830317167","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levothyroxin Tab 300mcg","code_information":[{"code":"CP17744631830311431","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Levothyroxin Tab 50mcg","code_information":[{"code":"CP17744631830310848","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Levothyroxin Tab 50mcg","code_information":[{"code":"CP17744631830317034","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Levothyroxin Tab 75mcg","code_information":[{"code":"CP17744631830328849","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Levothyroxine 100mcg Tabs","code_information":[{"code":"CP17744631830325279","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxine 100mcg Tabs","code_information":[{"code":"CP17744631830325418","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Levothyroxine 112mcg Tabs","code_information":[{"code":"CP17744631830329642","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":112,"type":"ME"}},{"description":"Levothyroxine 125mcg Tabs","code_information":[{"code":"CP17744631830328127","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Levothyroxine 125mcg Tabs","code_information":[{"code":"CP17744631830322519","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Levothyroxine 150mcg Tabs","code_information":[{"code":"CP17744631830321532","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Levothyroxine 175mcg Tabs","code_information":[{"code":"CP17744631830320916","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":175,"type":"ME"}},{"description":"Levothyroxine 25mcg Tabs","code_information":[{"code":"CP17744631830323538","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levothyroxine 25mcg Tabs","code_information":[{"code":"CP17744631830328845","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levothyroxine 50mcg Tabs","code_information":[{"code":"CP17744631830324373","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Levothyroxine 75mcg Tabs","code_information":[{"code":"CP17744631830324550","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Levothyroxine 75mcg Tabs","code_information":[{"code":"CP17744631830329984","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Levothyroxine 88mcg Tabs","code_information":[{"code":"CP17744631830323885","type":"CDM"},{"code":"250","type":"RC"},{"code":"78151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"Lidocaine    Cre 4%","code_information":[{"code":"CP17744631830336487","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830339132","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383093355","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine/prilo 2.5-2.5% Cream","code_information":[{"code":"CP17744631830349279","type":"CDM"},{"code":"250","type":"RC"},{"code":"11514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Lindane      Sha 1%","code_information":[{"code":"CP17744631830342759","type":"CDM"},{"code":"250","type":"RC"},{"code":"60432083460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lisinop/hctz Tab 10-12.5","code_information":[{"code":"CP17744631830342261","type":"CDM"},{"code":"250","type":"RC"},{"code":"18571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Lisinopril   Tab 40mg","code_information":[{"code":"CP17744631830358249","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180051703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lisinopril   Tab 40mg","code_information":[{"code":"CP17744631830350021","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180051701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lisinopril 40mg Tabs","code_information":[{"code":"CP17744631830358216","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180051703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Listerine    Liq Antisept","code_information":[{"code":"CP17744631830359382","type":"CDM"},{"code":"250","type":"RC"},{"code":"12547070128","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Listerine    Liq Antisept","code_information":[{"code":"CP17744631830358380","type":"CDM"},{"code":"250","type":"RC"},{"code":"12547070131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Loperamide 1mg/7.5ml Susp","code_information":[{"code":"CP17744631830366129","type":"CDM"},{"code":"250","type":"RC"},{"code":"11306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Loraz1mg/diphe12.5mg/hald0.5mg","code_information":[{"code":"CP17744631830360109","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Loraze2mg/diphen25mg/hal2mg","code_information":[{"code":"CP17744631830362924","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lorazepam    Tab 0.5mg","code_information":[{"code":"CP17744631830368567","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lorazepam    Tab 0.5mg","code_information":[{"code":"CP17744631830363084","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lorazepam    Tab 0.5mg","code_information":[{"code":"CP17744631830362318","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lorazepam    Tab 1mg","code_information":[{"code":"CP17744631830365172","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Lorazepam    Tab 1mg","code_information":[{"code":"CP17744631830364477","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Lorazepam    Tab 2mg","code_information":[{"code":"CP17744631830363115","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lorazepam    Tab 2mg","code_information":[{"code":"CP17744631830369849","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lorazepam    Tab 2mg","code_information":[{"code":"CP17744631830360743","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lorazepam 0.25mg/ml Top Gel","code_information":[{"code":"CP17744631830368255","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lorazepam 0.5mg Tabs","code_information":[{"code":"CP17744631830367416","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lorazepam 0.5mg Tabs","code_information":[{"code":"CP17744631830364480","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lorazepam 0.5mg/ml Top Gel","code_information":[{"code":"CP17744631830361820","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lorazepam 1mg Tabs","code_information":[{"code":"CP17744631830363606","type":"CDM"},{"code":"250","type":"RC"},{"code":"59102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Losartan 50mg Tabs","code_information":[{"code":"CP17744631830378810","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Losartan Pot Tab 100mg","code_information":[{"code":"CP17744631830378077","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Losartan Pot Tab 100mg","code_information":[{"code":"CP17744631830372304","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Losartan Pot Tab 100mg","code_information":[{"code":"CP17744631830378517","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Losartan Pot Tab 50mg","code_information":[{"code":"CP17744631830374595","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Losartan/hct 100-12.5 Tab","code_information":[{"code":"CP17744631830374374","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830373635","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 50-12.5","code_information":[{"code":"CP17744631830375651","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Lovastatin   Tab 10mg","code_information":[{"code":"CP17744631830373801","type":"CDM"},{"code":"250","type":"RC"},{"code":"18500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lovastatin   Tab 40mg","code_information":[{"code":"CP17744631830376949","type":"CDM"},{"code":"250","type":"RC"},{"code":"18500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lovaza       Cap 1gm","code_information":[{"code":"CP17744631830370131","type":"CDM"},{"code":"250","type":"RC"},{"code":"17308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Lubricating  Gel Jelly","code_information":[{"code":"CP17744631830383178","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295012532","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Maxorb Extra Pad 2\"x2\"","code_information":[{"code":"CP17744631830406030","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327056130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Maxorb Extra Pad 4\"x4\"","code_information":[{"code":"CP17744631830406970","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327056229","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Memantine 2mg/ml Soln","code_information":[{"code":"CP17744631830422394","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328055112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Memantine Hc Cap 14mg Er","code_information":[{"code":"CP17744631830423594","type":"CDM"},{"code":"250","type":"RC"},{"code":"37854","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Memantine Hc Cap 7mg Er","code_information":[{"code":"CP17744631830429199","type":"CDM"},{"code":"250","type":"RC"},{"code":"37854","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Mesalamine   Tab 1.2gm","code_information":[{"code":"CP17744631830434022","type":"CDM"},{"code":"250","type":"RC"},{"code":"37874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":12,"type":"GR"}},{"description":"Mesalamine   Tab 800mg Dr","code_information":[{"code":"CP17744631830439548","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382048428","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Mesalamine Dr 800mg Tabs","code_information":[{"code":"CP17744631830438000","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382048428","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Metamucil    Pow 28%org","code_information":[{"code":"CP17744631830431653","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000074087","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metamucil    Pow 4 In 1","code_information":[{"code":"CP17744631830433239","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000074087","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metamucil Pow Packets","code_information":[{"code":"CP17744631830439085","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000074087","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metformin    Tab 500mg Er","code_information":[{"code":"CP17744631830434867","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714093801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Methazolamid Tab 50mg","code_information":[{"code":"CP17744631830447132","type":"CDM"},{"code":"250","type":"RC"},{"code":"78110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Methlphenida Chw 2.5mg","code_information":[{"code":"CP17744631830442853","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386057001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mi-acid      Sus","code_information":[{"code":"CP17744631830474502","type":"CDM"},{"code":"250","type":"RC"},{"code":"90468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mi-acid Gas  Chw 80mg","code_information":[{"code":"CP17744631830479929","type":"CDM"},{"code":"250","type":"RC"},{"code":"90450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Miconazole 1 Kit 1200-2%","code_information":[{"code":"CP17744631830470321","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000031501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Midazolam    Inj 10mg/2ml","code_information":[{"code":"CP17744631830485992","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine    Tab 5mg","code_information":[{"code":"CP17744631830488555","type":"CDM"},{"code":"250","type":"RC"},{"code":"18500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Minoxidil    Sol 5% Men","code_information":[{"code":"CP17744631830497801","type":"CDM"},{"code":"250","type":"RC"},{"code":"47200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Mirtazapine  Tab 7.5mg","code_information":[{"code":"CP17744631830490073","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Mirtazapine 15mg Tabs","code_information":[{"code":"CP17744631830492637","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mirtazapine 30mg Tabs","code_information":[{"code":"CP17744631830494854","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Mirtazapine 7.5mg Tabs","code_information":[{"code":"CP17744631830490113","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Mometasone   Sol 0.1%","code_information":[{"code":"CP17744631830499318","type":"CDM"},{"code":"250","type":"RC"},{"code":"71307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mometasone   Spr 50mcg","code_information":[{"code":"CP17744631830509594","type":"CDM"},{"code":"250","type":"RC"},{"code":"78163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Morphine Sul Cap 50mg Er","code_information":[{"code":"CP17744631830504217","type":"CDM"},{"code":"250","type":"RC"},{"code":"11512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Morphine Sul Tab 30mg Er","code_information":[{"code":"CP17744631830505772","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629108801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Muc/cgh Relf Liq 5-100mg","code_information":[{"code":"CP17744631830513482","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mucus Relf D Tab 60-600mg","code_information":[{"code":"CP17744631830519777","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Mucus Relf D Tab 60-600mg","code_information":[{"code":"CP17744631830519297","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Mucus Relief Tab 400mg","code_information":[{"code":"CP17744631830511517","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896079401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Mucus Relief Tab 400mg","code_information":[{"code":"CP17744631830513625","type":"CDM"},{"code":"250","type":"RC"},{"code":"90468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Mucus Relief Tab Dm Cough","code_information":[{"code":"CP17744631830513938","type":"CDM"},{"code":"250","type":"RC"},{"code":"90468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Multaq       Tab 400mg","code_information":[{"code":"CP17744631830522690","type":"CDM"},{"code":"250","type":"RC"},{"code":"24414","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Multivit/fl  Chw 1mg","code_information":[{"code":"CP17744631830525798","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269015301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Multivitamin Chw Children","code_information":[{"code":"CP17744631830524521","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681004800","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830536830","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729008110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Naltrexone 3mg Capsule","code_information":[{"code":"CP17744631830533892","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729008110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Naltrexone 4.5mg Caps","code_information":[{"code":"CP17744631830530126","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729008110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Nasonex      Spr 50mcg/ac","code_information":[{"code":"CP17744631830541099","type":"CDM"},{"code":"250","type":"RC"},{"code":"85128","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Natacyn      Sus 5% Op","code_information":[{"code":"CP17744631830544936","type":"CDM"},{"code":"250","type":"RC"},{"code":"65064","type":"CPT","modifier":"515"}],"standard_charges":[{"setting":"outpatient","modifier_code":["515"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Neo/poly/dex Oin 0.1% Op","code_information":[{"code":"CP17744631830547872","type":"CDM"},{"code":"250","type":"RC"},{"code":"57441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neutrogena   Sha","code_information":[{"code":"CP17744631830552578","type":"CDM"},{"code":"250","type":"RC"},{"code":"70501001640","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"New Skin     Liq","code_information":[{"code":"CP17744631830553952","type":"CDM"},{"code":"250","type":"RC"},{"code":"75137070331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nicotine 4mg Lozenge","code_information":[{"code":"CP17744631830557390","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000012100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nighttime    Liq Cold/flu","code_information":[{"code":"CP17744631830566105","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000045301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitrofurantn Cap 100mg","code_information":[{"code":"CP17744631830565453","type":"CDM"},{"code":"250","type":"RC"},{"code":"37834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitroglycer  Dis 0.2mg/hr","code_information":[{"code":"CP17744631830568013","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382030930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nitroglycerin 0.4mg/hr Patch","code_information":[{"code":"CP17744631830560122","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382031030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nivea        Cre","code_information":[{"code":"CP17744631830578279","type":"CDM"},{"code":"250","type":"RC"},{"code":"72140080132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nizoral A-d  Sha 1%","code_information":[{"code":"CP17744631830573751","type":"CDM"},{"code":"250","type":"RC"},{"code":"55505019133","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olanzapine 20mg Tabs","code_information":[{"code":"CP17744631830671379","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668017130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olmesartan 40mg Tabs","code_information":[{"code":"CP17744631830675412","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382064516","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Omeprazole   Cap 10mg","code_information":[{"code":"CP17744631830673683","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714074601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Omeprazole   Cap 20mg","code_information":[{"code":"CP17744631830682870","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714074703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Omeprazole   Cap 20mg","code_information":[{"code":"CP17744631830686499","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714074702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Omeprazole   Tab 20mg","code_information":[{"code":"CP17744631830686062","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Omeprazole   Tab 20mg","code_information":[{"code":"CP17744631830686080","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Omeprazole 20mg Caps","code_information":[{"code":"CP17744631830683193","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714074703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Onetouch     Mis Lancets","code_information":[{"code":"CP17744631830680436","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885004610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Optifoam     Pad 4 X 4\"","code_information":[{"code":"CP17744631830692377","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329045140","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oseltamivir  Cap 30mg","code_information":[{"code":"CP17744631830690472","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830694394","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oseltamivir  Cap 75mg","code_information":[{"code":"CP17744631830691456","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739005007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Oseltamivir 30mg Caps","code_information":[{"code":"CP17744631830691173","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycod/apap  Tab 2.5-325","code_information":[{"code":"CP17744631830719546","type":"CDM"},{"code":"250","type":"RC"},{"code":"60349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Oxycodone    Tab 15mg","code_information":[{"code":"CP17744631830716002","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084018401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Ozempic      Inj 2/1.5ml","code_information":[{"code":"CP17744631830729296","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Ozempic (1mg Dose) 2mg/1.5ml","code_information":[{"code":"CP17744631830720519","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ozempic 1mg Doses (2mg/1.5ml)","code_information":[{"code":"CP17744631830723426","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ozempic-2mg/1.5ml 1mg Dose","code_information":[{"code":"CP17744631830728637","type":"CDM"},{"code":"250","type":"RC"},{"code":"16941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Pain & Fever Sus 160/5ml","code_information":[{"code":"CP17744631830726973","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011024701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Paxlovid     Tab","code_information":[{"code":"CP17744631830743462","type":"CDM"},{"code":"250","type":"RC"},{"code":"69108","type":"CPT","modifier":"506"}],"standard_charges":[{"setting":"outpatient","modifier_code":["506"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paxlovid     Tab 300-100","code_information":[{"code":"CP17744631830747111","type":"CDM"},{"code":"250","type":"RC"},{"code":"69108","type":"CPT","modifier":"506"}],"standard_charges":[{"setting":"outpatient","modifier_code":["506"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Ped Elctrlyt Sol Unflavor","code_information":[{"code":"CP17744631830746516","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295013812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pentoxifylli Tab 400mg Er","code_information":[{"code":"CP17744631830743907","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682010150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Peptic 262mg Chew","code_information":[{"code":"CP17744631830751344","type":"CDM"},{"code":"250","type":"RC"},{"code":"53610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":262,"type":"ME"}},{"description":"Peptic Relf  Chw 262mg","code_information":[{"code":"CP17744631830756246","type":"CDM"},{"code":"250","type":"RC"},{"code":"53610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":262,"type":"ME"}},{"description":"Perphenazine 4mg Tabs","code_information":[{"code":"CP17744631830757847","type":"CDM"},{"code":"250","type":"RC"},{"code":"78110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Petroleum    Gel Jelly","code_information":[{"code":"CP17744631830757287","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000001901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenazopyrid Tab 100mg","code_information":[{"code":"CP17744631830756857","type":"CDM"},{"code":"250","type":"RC"},{"code":"42937070110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phenazopyridine 100mg Tabs","code_information":[{"code":"CP17744631830753658","type":"CDM"},{"code":"250","type":"RC"},{"code":"42937070110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phenobarb    Tab 15mg","code_information":[{"code":"CP17744631830757196","type":"CDM"},{"code":"250","type":"RC"},{"code":"14314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Phytoplex Z-guard Paste 57-17%","code_information":[{"code":"CP17744631830768927","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329013744","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Picato       Gel 0.05%","code_information":[{"code":"CP17744631830769542","type":"CDM"},{"code":"250","type":"RC"},{"code":"50222050347","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830770581","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830774109","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Piper/tazoba Inj 2-0.25gm","code_information":[{"code":"CP17744631830776117","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457052122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Piper/tazoba Inj 3-0.375g","code_information":[{"code":"CP17744631830782341","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457052237","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Poly Bacitra Oin","code_information":[{"code":"CP17744631830788779","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000047101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Pow 20meq","code_information":[{"code":"CP17744631830794784","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543037930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Tab 10meq Er","code_information":[{"code":"CP17744631830795542","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386091510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pot Chloride Tab 20meq Er","code_information":[{"code":"CP17744631830791864","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386091710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Pot Chloride Tab 8meq Sr","code_information":[{"code":"CP17744631830791082","type":"CDM"},{"code":"250","type":"RC"},{"code":"78115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Pot Cl Micro Tab 10meq Er","code_information":[{"code":"CP17744631830793840","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pot Cl Micro Tab 20meq Er","code_information":[{"code":"CP17744631830797292","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Potassium Chl Er 10meq Tabs","code_information":[{"code":"CP17744631830798962","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Potassium Chl Er 20meq Tabs","code_information":[{"code":"CP17744631830800916","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Potassium Chl Er 20meq Tabs","code_information":[{"code":"CP17744631830806708","type":"CDM"},{"code":"250","type":"RC"},{"code":"78157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Povidone-iod Mis Swab 10%","code_information":[{"code":"CP17744631830809521","type":"CDM"},{"code":"250","type":"RC"},{"code":"52380410101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Povidone-iod Mis Swab 10%","code_information":[{"code":"CP17744631830807266","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329094509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Povidone-iod Oin 10%","code_information":[{"code":"CP17744631830806372","type":"CDM"},{"code":"250","type":"RC"},{"code":"90411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pramipexole  Tab 1.5mg","code_information":[{"code":"CP17744631830801274","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pravastatin  Tab 10mg","code_information":[{"code":"CP17744631830800330","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pravastatin 80mg Tabs","code_information":[{"code":"CP17744631830800013","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Prednisolone Tab 10mg Odt","code_information":[{"code":"CP17744631830810770","type":"CDM"},{"code":"250","type":"RC"},{"code":"37847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prednisolone Tab 10mg Odt","code_information":[{"code":"CP17744631830816549","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993084462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prevagen     Cap 20mg","code_information":[{"code":"CP17744631830821139","type":"CDM"},{"code":"250","type":"RC"},{"code":"94047000110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Prevagen 20mg Caps","code_information":[{"code":"CP17744631830820990","type":"CDM"},{"code":"250","type":"RC"},{"code":"94047000110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Primidone    Tab 50mg","code_information":[{"code":"CP17744631830835799","type":"CDM"},{"code":"250","type":"RC"},{"code":"90455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Proben/colch Tab 500-0.5","code_information":[{"code":"CP17744631830830905","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980014901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Propafenone  Cap 325mg Er","code_information":[{"code":"CP17744631830841646","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571073706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Propafenone  Cap 325mg Er","code_information":[{"code":"CP17744631830841289","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462040960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Propafenone  Cap 325mg Er","code_information":[{"code":"CP17744631830846608","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714082601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Propafenone  Cap 425mg Er","code_information":[{"code":"CP17744631830842401","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462041060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":425,"type":"ME"}},{"description":"Puralube     Oin","code_information":[{"code":"CP17744631830855611","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Qmiiz Odt    Tab 15 Mg","code_information":[{"code":"CP17744631830858443","type":"CDM"},{"code":"250","type":"RC"},{"code":"70720011599","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Qnapril/hctz Tab 10-12.5","code_information":[{"code":"CP17744631830853846","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Quiet Please Mis Ear Plug","code_information":[{"code":"CP17744631830862384","type":"CDM"},{"code":"250","type":"RC"},{"code":"23185008150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Regen-cov    Inj 600/600","code_information":[{"code":"CP17744631830880249","type":"CDM"},{"code":"250","type":"RC"},{"code":"61755003901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":600,"type":"EA"}},{"description":"Remedy       Cre Antifung","code_information":[{"code":"CP17744631830887882","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329016204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Remedy       Pst Calazime","code_information":[{"code":"CP17744631830888561","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329015204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Remedy Calaz Pst Olivamin","code_information":[{"code":"CP17744631830884815","type":"CDM"},{"code":"250","type":"RC"},{"code":"80196030615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Remedy Moist Cre 5%","code_information":[{"code":"CP17744631830880262","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329015104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Remedy Phyto Cre Hydragua","code_information":[{"code":"CP17744631830888668","type":"CDM"},{"code":"250","type":"RC"},{"code":"84389011146","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Remedy Phyto Oin Af 2%","code_information":[{"code":"CP17744631830886200","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329017110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Remedy Skin  Cre Repair","code_information":[{"code":"CP17744631830884660","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329016104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Remedy Z-guard Paste 57-17%","code_information":[{"code":"CP17744631830887624","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329013744","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Repaglinide  Tab 0.5mg","code_information":[{"code":"CP17744631830883657","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862067001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Replens      Gel Vag","code_information":[{"code":"CP17744631830899507","type":"CDM"},{"code":"250","type":"RC"},{"code":"66715083035","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Replens      Gel Vag","code_information":[{"code":"CP17744631830890916","type":"CDM"},{"code":"250","type":"RC"},{"code":"66715083008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rhinocort    Sus Allergy","code_information":[{"code":"CP17744631830898981","type":"CDM"},{"code":"250","type":"RC"},{"code":"45064","type":"CPT","modifier":"612"}],"standard_charges":[{"setting":"outpatient","modifier_code":["612"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Riluzole     Tab 50mg","code_information":[{"code":"CP17744631830893749","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505328506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Risperidone  Tab 1mg Odt","code_information":[{"code":"CP17744631830901910","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Risperidone  Tab 3mg Odt","code_information":[{"code":"CP17744631830905710","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Risperidone  Tab 4mg Odt","code_information":[{"code":"CP17744631830904354","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Safe Tussin  Liq 10-100/5","code_information":[{"code":"CP17744631830929528","type":"CDM"},{"code":"250","type":"RC"},{"code":"55505011133","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Safe Tussin  Liq Pm","code_information":[{"code":"CP17744631830921332","type":"CDM"},{"code":"250","type":"RC"},{"code":"55505017333","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Safe Tussin Liq Dm 10-100/5","code_information":[{"code":"CP17744631830921137","type":"CDM"},{"code":"250","type":"RC"},{"code":"55505011133","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Saline Flush 0.9% Soln","code_information":[{"code":"CP17744631830928897","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807010091","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Saline Flush Inj Zr 0.9%","code_information":[{"code":"CP17744631830929231","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807010091","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Selenium Sul Sha 2.25%","code_information":[{"code":"CP17744631830993844","type":"CDM"},{"code":"250","type":"RC"},{"code":"42582090006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Senna 8.6mg Tablet","code_information":[{"code":"CP17744631831001607","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896045101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":86,"type":"ME"}},{"description":"Sensi-care   Oin 49-15%","code_information":[{"code":"CP17744631831001143","type":"CDM"},{"code":"250","type":"RC"},{"code":"43553325604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":49,"type":"EA"}},{"description":"Serevent Dis Aer 50mcg","code_information":[{"code":"CP17744631831001021","type":"CDM"},{"code":"250","type":"RC"},{"code":"17305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Simethicone  Cap 180mg","code_information":[{"code":"CP17744631831021336","type":"CDM"},{"code":"250","type":"RC"},{"code":"53636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Simethicone  Chw 80mg","code_information":[{"code":"CP17744631831026029","type":"CDM"},{"code":"250","type":"RC"},{"code":"90450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Simethicone 40mg/0.6ml Drops","code_information":[{"code":"CP17744631831027474","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Simethicone 80mg Chew","code_information":[{"code":"CP17744631831026578","type":"CDM"},{"code":"250","type":"RC"},{"code":"90450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Simvastatin  Tab 80mg","code_information":[{"code":"CP17744631831024834","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382006905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Single Syringe Fee","code_information":[{"code":"CP17744631831026196","type":"CDM"},{"code":"250","type":"RC"},{"code":"99992154645","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Skintegrity  Gel Hydrogel","code_information":[{"code":"CP17744631831029106","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327000103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Skintegrity  Gel Hydrogel","code_information":[{"code":"CP17744631831026161","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327000104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Skintegrity  Pad 2\"x2\"","code_information":[{"code":"CP17744631831022516","type":"CDM"},{"code":"250","type":"RC"},{"code":"8327048729","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831040410","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831046816","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807010055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831044916","type":"CDM"},{"code":"250","type":"RC"},{"code":"63807010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Sodium Fluor Gel 1.1%","code_information":[{"code":"CP17744631831057274","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657049102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":11,"type":"EA"}},{"description":"Solifenacin  Tab 10mg","code_information":[{"code":"CP17744631831052907","type":"CDM"},{"code":"250","type":"RC"},{"code":"93526","type":"CPT","modifier":"456"}],"standard_charges":[{"setting":"outpatient","modifier_code":["456"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831055868","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505470209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Solifenacin  Tab 5mg","code_information":[{"code":"CP17744631831058899","type":"CDM"},{"code":"250","type":"RC"},{"code":"93526","type":"CPT","modifier":"356"}],"standard_charges":[{"setting":"outpatient","modifier_code":["356"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Sorbitol     Sol 70%","code_information":[{"code":"CP17744631831057122","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896043516","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":70,"type":"EA"}},{"description":"Spironolact  Tab 25mg","code_information":[{"code":"CP17744631831063079","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629106403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Stiolto      Aer 2.5-2.5","code_information":[{"code":"CP17744631831064524","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Stiolto 2.5/2.5 (60)","code_information":[{"code":"CP17744631831068633","type":"CDM"},{"code":"250","type":"RC"},{"code":"59701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stool Softnr Tab 8.6-50mg","code_information":[{"code":"CP17744631831073913","type":"CDM"},{"code":"250","type":"RC"},{"code":"57896030301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":86,"type":"ME"}},{"description":"Sucralfate   Tab 1gm","code_information":[{"code":"CP17744631831078736","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578008101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Sumatriptan  Inj 6mg/0.5","code_information":[{"code":"CP17744631831087099","type":"CDM"},{"code":"250","type":"RC"},{"code":"78131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Sumatriptan  Tab 50mg","code_information":[{"code":"CP17744631831082811","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714053211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tab-a-vite   Tab","code_information":[{"code":"CP17744631831094179","type":"CDM"},{"code":"250","type":"RC"},{"code":"90405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tadalafil    Tab 5mg","code_information":[{"code":"CP17744631831097697","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505468403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831103528","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862044601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Taron-prex   Cap","code_information":[{"code":"CP17744631831109293","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811054330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Temazepam    Cap 15mg","code_information":[{"code":"CP17744631831108407","type":"CDM"},{"code":"250","type":"RC"},{"code":"37840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Temazepam    Cap 7.5mg","code_information":[{"code":"CP17744631831114470","type":"CDM"},{"code":"250","type":"RC"},{"code":"53489064801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Temazepam    Cap 7.5mg","code_information":[{"code":"CP17744631831117855","type":"CDM"},{"code":"250","type":"RC"},{"code":"37831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Terazosin    Cap 1mg","code_information":[{"code":"CP17744631831112754","type":"CDM"},{"code":"250","type":"RC"},{"code":"37822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Terbinafine  Tab 250mg","code_information":[{"code":"CP17744631831119256","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714050102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Terbinafine  Tab 250mg","code_information":[{"code":"CP17744631831116635","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714050101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Tetrabenazin Tab 25mg","code_information":[{"code":"CP17744631831126361","type":"CDM"},{"code":"250","type":"RC"},{"code":"54046","type":"CPT","modifier":"923"}],"standard_charges":[{"setting":"outpatient","modifier_code":["923"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tobradex     Oin 0.3-0.1%","code_information":[{"code":"CP17744631831146686","type":"CDM"},{"code":"250","type":"RC"},{"code":"65064","type":"CPT","modifier":"835"}],"standard_charges":[{"setting":"outpatient","modifier_code":["835"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Tobradex St  Sus 0.3-0.05","code_information":[{"code":"CP17744631831148830","type":"CDM"},{"code":"250","type":"RC"},{"code":"65065","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Tobradex St Ophth Susp","code_information":[{"code":"CP17744631831142575","type":"CDM"},{"code":"250","type":"RC"},{"code":"65065","type":"CPT","modifier":"205"}],"standard_charges":[{"setting":"outpatient","modifier_code":["205"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tolnaftate   Pow 1%","code_information":[{"code":"CP17744631831141927","type":"CDM"},{"code":"250","type":"RC"},{"code":"53651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tolvaptan    Tab 15mg","code_information":[{"code":"CP17744631831157286","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505470400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Tramadl/apap Tab 37.5-325","code_information":[{"code":"CP17744631831150408","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Tranex Acid  Tab 650mg","code_information":[{"code":"CP17744631831169819","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505363803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Trazodone    Tab 300mg","code_information":[{"code":"CP17744631831162355","type":"CDM"},{"code":"250","type":"RC"},{"code":"55507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Trimethoprim Tab 100mg","code_information":[{"code":"CP17744631831196467","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386033001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Trolamine    Cre Sal 10%","code_information":[{"code":"CP17744631831193944","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802035653","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Trospium Cl  Tab 20mg","code_information":[{"code":"CP17744631831192329","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505345406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ultrasite Valve","code_information":[{"code":"CP17744631831200633","type":"CDM"},{"code":"250","type":"RC"},{"code":"41511","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Unicomplex-m Tab","code_information":[{"code":"CP17744631831207306","type":"CDM"},{"code":"250","type":"RC"},{"code":"53647","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Utibron      Cap Neohaler","code_information":[{"code":"CP17744631831215610","type":"CDM"},{"code":"250","type":"RC"},{"code":"63402068160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vanco 1gm/250ml Sod Cl 0.9%","code_information":[{"code":"CP17744631831228902","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancocin 250mg/10ml","code_information":[{"code":"CP17744631831230433","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831232944","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001033964","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831236396","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991094117","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 1 Gm","code_information":[{"code":"CP17744631831235986","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Vancomycin   Inj 10gm","code_information":[{"code":"CP17744631831232176","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831232095","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001033862","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin   Inj 500mg","code_information":[{"code":"CP17744631831238855","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991094017","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Vancomycin 25 Mg/ml Oral Soln","code_information":[{"code":"CP17744631831248721","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vancomycin 250mg/5ml","code_information":[{"code":"CP17744631831246814","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin 250mg/5ml 200ml","code_information":[{"code":"CP17744631831244256","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vancomycin 25mg/ml","code_information":[{"code":"CP17744631831248454","type":"CDM"},{"code":"250","type":"RC"},{"code":"40965","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Venlafaxine Er 150mg Caps","code_information":[{"code":"CP17744631831261342","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382003606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Vibramycin   Syp 50mg/5ml","code_information":[{"code":"CP17744631831260645","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097","type":"CPT","modifier":"195"}],"standard_charges":[{"setting":"outpatient","modifier_code":["195"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Viokace      Tab 10440","code_information":[{"code":"CP17744631831271669","type":"CDM"},{"code":"250","type":"RC"},{"code":"58914011210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10440,"type":"EA"}},{"description":"Vitamin A&d  Oin","code_information":[{"code":"CP17744631831271069","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385007026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vitamin D    Tab 1000unit","code_information":[{"code":"CP17744631831293111","type":"CDM"},{"code":"250","type":"RC"},{"code":"53633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"UN"}},{"description":"Vitamin D    Tab 2000unit","code_information":[{"code":"CP17744631831290481","type":"CDM"},{"code":"250","type":"RC"},{"code":"90461","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2000,"type":"UN"}},{"description":"Vitamin D3   Tab 2000unit","code_information":[{"code":"CP17744631831291923","type":"CDM"},{"code":"250","type":"RC"},{"code":"90461","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2000,"type":"UN"}},{"description":"Vitamin D3   Tab 5000unit","code_information":[{"code":"CP17744631831295335","type":"CDM"},{"code":"250","type":"RC"},{"code":"96295012846","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Vitamin D3 1000iu Tabs","code_information":[{"code":"CP17744631831292488","type":"CDM"},{"code":"250","type":"RC"},{"code":"53633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1000,"type":"F2"}},{"description":"Vitamin D3 2000iu Tabs","code_information":[{"code":"CP17744631831298509","type":"CDM"},{"code":"250","type":"RC"},{"code":"90461","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":2000,"type":"F2"}},{"description":"Vitamins &   Tab Minerals","code_information":[{"code":"CP17744631831306214","type":"CDM"},{"code":"250","type":"RC"},{"code":"90450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Voltaren     Gel 1%","code_information":[{"code":"CP17744631831300347","type":"CDM"},{"code":"250","type":"RC"},{"code":"63481068447","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zenpep       Cap 10000unt","code_information":[{"code":"CP17744631831396012","type":"CDM"},{"code":"250","type":"RC"},{"code":"23611","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":10000,"type":"EA"}},{"description":"Zenpep       Cap 15000unt","code_information":[{"code":"CP17744631831395645","type":"CDM"},{"code":"250","type":"RC"},{"code":"23611","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":15000,"type":"EA"}},{"description":"Zenpep       Cap 20000unt","code_information":[{"code":"CP17744631831390645","type":"CDM"},{"code":"250","type":"RC"},{"code":"23611","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20000,"type":"EA"}},{"description":"Zenpep       Cap 40000","code_information":[{"code":"CP17744631831392539","type":"CDM"},{"code":"250","type":"RC"},{"code":"23611","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":40000,"type":"EA"}},{"description":"Zenpep 5000 Units Caps","code_information":[{"code":"CP17744631831395104","type":"CDM"},{"code":"250","type":"RC"},{"code":"23611","type":"CPT","modifier":"501"}],"standard_charges":[{"setting":"outpatient","modifier_code":["501"],"minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Z-guard      Pst 57-17%","code_information":[{"code":"CP17744631831394048","type":"CDM"},{"code":"250","type":"RC"},{"code":"84389011116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Z-guard      Pst 57-17%","code_information":[{"code":"CP17744631831391813","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329013744","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide   Oin 20%","code_information":[{"code":"CP17744631831391890","type":"CDM"},{"code":"250","type":"RC"},{"code":"53657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Zinc Oxide   Oin 20%","code_information":[{"code":"CP17744631831396168","type":"CDM"},{"code":"250","type":"RC"},{"code":"53657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Zinc Oxide   Oin 20%","code_information":[{"code":"CP17744631831408242","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122011846","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Zinc Oxide   Oin 20%","code_information":[{"code":"CP17744631831406392","type":"CDM"},{"code":"250","type":"RC"},{"code":"53657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Zinc Oxide Crm 20% /Petrolatum","code_information":[{"code":"CP17744631831407377","type":"CDM"},{"code":"250","type":"RC"},{"code":"53657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide/dermaphor/nystatin","code_information":[{"code":"CP17744631831407408","type":"CDM"},{"code":"250","type":"RC"},{"code":"53657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zn/ad/ny/ma Butt Cream","code_information":[{"code":"CP17744631831408960","type":"CDM"},{"code":"250","type":"RC"},{"code":"53657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zuplenz      Mis 8mg","code_information":[{"code":"CP17744631831412094","type":"CDM"},{"code":"250","type":"RC"},{"code":"89141044830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":2,"maximum":2,"gross_charge":2,"discounted_cash":2,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":2},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":2}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828516368","type":"CDM"},{"code":"250","type":"RC"},{"code":"64850051101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Claritin-d   Tab 10-240mg","code_information":[{"code":"CP17744631829243127","type":"CDM"},{"code":"250","type":"RC"},{"code":"11523433203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829269869","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hc Butyrate  Oin 0.1%","code_information":[{"code":"CP17744631830070040","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682027115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nefazodone   Tab 100mg","code_information":[{"code":"CP17744631830549180","type":"CDM"},{"code":"250","type":"RC"},{"code":"93102","type":"CPT","modifier":"406"}],"standard_charges":[{"setting":"outpatient","modifier_code":["406"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nifedipine   Cap 10mg","code_information":[{"code":"CP17744631830562427","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315021101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pnv-omega    Cap","code_information":[{"code":"CP17744631830784862","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192033230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Protriptylin Tab 10mg","code_information":[{"code":"CP17744631830857063","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794000702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Temazepam    Cap 22.5mg","code_information":[{"code":"CP17744631831111374","type":"CDM"},{"code":"250","type":"RC"},{"code":"40699","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831142616","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436016004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Valproic Acd Cap 250mg","code_information":[{"code":"CP17744631831220561","type":"CDM"},{"code":"250","type":"RC"},{"code":"83203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Vilazodone   Tab 10mg","code_information":[{"code":"CP17744631831274615","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729035210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vilazodone   Tab 20mg","code_information":[{"code":"CP17744631831270411","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729035310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vilazodone   Tab 40mg","code_information":[{"code":"CP17744631831276386","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729035410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-40mg","code_information":[{"code":"CP17744631828489932","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462056990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-40mg","code_information":[{"code":"CP17744631828489169","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-40mg","code_information":[{"code":"CP17744631828489238","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-40mg","code_information":[{"code":"CP17744631828481615","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862085730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-40mg","code_information":[{"code":"CP17744631828483268","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862085530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cyclobenzapr Tab 5mg","code_information":[{"code":"CP17744631829438431","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300041301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Desipramine  Tab 150mg","code_information":[{"code":"CP17744631829562994","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742011750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Kerasal      Liq Fungal","code_information":[{"code":"CP17744631830187365","type":"CDM"},{"code":"250","type":"RC"},{"code":"57074000161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Kerasal      Sol Fungal","code_information":[{"code":"CP17744631830189310","type":"CDM"},{"code":"250","type":"RC"},{"code":"57074000161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 25mg","code_information":[{"code":"CP17744631830218503","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine 25mg Tabs","code_information":[{"code":"CP17744631830214975","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine Tab 25mg","code_information":[{"code":"CP17744631830213708","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metamucil    Pak 4 In 1","code_information":[{"code":"CP17744631830434727","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000002404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metamucil    Pow 58.12%","code_information":[{"code":"CP17744631830432333","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000002404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metamucil 4-in-1 Sugar Free Pk","code_information":[{"code":"CP17744631830430054","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000002404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metamucil Pow Packets","code_information":[{"code":"CP17744631830433870","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000002404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenidate 36mg Er Tab","code_information":[{"code":"CP17744631830453940","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811070810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":36,"type":"ME"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830679306","type":"CDM"},{"code":"250","type":"RC"},{"code":"93500","type":"CPT","modifier":"456"}],"standard_charges":[{"setting":"outpatient","modifier_code":["456"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830673219","type":"CDM"},{"code":"250","type":"RC"},{"code":"93500","type":"CPT","modifier":"256"}],"standard_charges":[{"setting":"outpatient","modifier_code":["256"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830673611","type":"CDM"},{"code":"250","type":"RC"},{"code":"93500","type":"CPT","modifier":"356"}],"standard_charges":[{"setting":"outpatient","modifier_code":["356"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olm+aml Hctz 40/5/25mg Tab","code_information":[{"code":"CP17744631830677361","type":"CDM"},{"code":"250","type":"RC"},{"code":"93500","type":"CPT","modifier":"456"}],"standard_charges":[{"setting":"outpatient","modifier_code":["456"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olm+aml Hctz 40/5/25mg Tab","code_information":[{"code":"CP17744631830670553","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884078809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Oxybutynin   Tab 10mg Er","code_information":[{"code":"CP17744631830709956","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382025601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxybutynin Er 10mg Tabs","code_information":[{"code":"CP17744631830704223","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382025601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pedialyte    Pak","code_information":[{"code":"CP17744631830747755","type":"CDM"},{"code":"250","type":"RC"},{"code":"70074064179","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Salonpas-hot Dis 0.025%","code_information":[{"code":"CP17744631830992554","type":"CDM"},{"code":"250","type":"RC"},{"code":"46581070003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Salonpas-hot Pad 0.025%","code_information":[{"code":"CP17744631830993533","type":"CDM"},{"code":"250","type":"RC"},{"code":"46581070003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xaquil Xr    Tab 30mg","code_information":[{"code":"CP17744631831389938","type":"CDM"},{"code":"250","type":"RC"},{"code":"53731000303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Zolpidem Er  Tab 6.25mg","code_information":[{"code":"CP17744631831412134","type":"CDM"},{"code":"250","type":"RC"},{"code":"95517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Amlod/benazp Cap 10-40mg","code_information":[{"code":"CP17744631828484664","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237014701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlodipine-benaz 10-40mg Cap","code_information":[{"code":"CP17744631828495077","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237014701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828506367","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714001402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Aripiprazole Sol 1mg/ml","code_information":[{"code":"CP17744631828744268","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651011055","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonazep Odt Tab 1mg","code_information":[{"code":"CP17744631829376700","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332036706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonazepam  Odt Tab 1mg","code_information":[{"code":"CP17744631829378986","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332036706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Freestyle    Tes","code_information":[{"code":"CP17744631830009615","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073012101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Freestyle    Tes Lite","code_information":[{"code":"CP17744631830001662","type":"CDM"},{"code":"250","type":"RC"},{"code":"99073070827","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lithium Carb Tab 300mg Er","code_information":[{"code":"CP17744631830358833","type":"CDM"},{"code":"250","type":"RC"},{"code":"37813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Metaxalone   Tab 800mg","code_information":[{"code":"CP17744631830431656","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268053015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Metformin    Tab 500mg","code_information":[{"code":"CP17744631830438057","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687015501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Phenytoin Ex Cap 300mg","code_information":[{"code":"CP17744631830767736","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756043288","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Progesterone Cap 200mg","code_information":[{"code":"CP17744631830830812","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700016301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tri-legest   Tab Fe","code_information":[{"code":"CP17744631831198909","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Varenicline  Tab 0.5& 1mg","code_information":[{"code":"CP17744631831245580","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462089504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ziprasidone  Cap 80mg","code_information":[{"code":"CP17744631831406511","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342014709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Alprazolam    Tab 1mg Odt","code_information":[{"code":"CP17744631828449785","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884021374","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Alprazolam   Tab 0.25mg","code_information":[{"code":"CP17744631828440617","type":"CDM"},{"code":"250","type":"RC"},{"code":"78110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Alprazolam   Tab 1mg Odt","code_information":[{"code":"CP17744631828449596","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884021374","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829217756","type":"CDM"},{"code":"250","type":"RC"},{"code":"83203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clozapine    Tab 50mg","code_information":[{"code":"CP17744631829393394","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664024188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clozapine 50mg Tabs","code_information":[{"code":"CP17744631829391131","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664024188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Continu-flo Set","code_information":[{"code":"CP17744631829417531","type":"CDM"},{"code":"250","type":"RC"},{"code":"85412051708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexmethylphe Cap 20mg Er","code_information":[{"code":"CP17744631829572503","type":"CDM"},{"code":"250","type":"RC"},{"code":"52781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829725439","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205004060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829727001","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452013217","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dofetilide   Cap 500mcg","code_information":[{"code":"CP17744631829722271","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205004160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hc Butyrate  Oin 0.1%","code_information":[{"code":"CP17744631830075196","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682027145","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Primary Tubing","code_information":[{"code":"CP17744631830175225","type":"CDM"},{"code":"250","type":"RC"},{"code":"85412051708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Latanoprost  Sol 0.005%","code_information":[{"code":"CP17744631830224555","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208046325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830308410","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954085220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methazolamid Tab 25mg","code_information":[{"code":"CP17744631830440195","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559024001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methylphenid Tab 18mg Er","code_information":[{"code":"CP17744631830459410","type":"CDM"},{"code":"250","type":"RC"},{"code":"52733","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Methylphenid Tab 18mg Er","code_information":[{"code":"CP17744631830458754","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037072501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Phenytek     Cap 200mg","code_information":[{"code":"CP17744631830762505","type":"CDM"},{"code":"250","type":"RC"},{"code":"37826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Phenytek     Cap 200mg","code_information":[{"code":"CP17744631830767828","type":"CDM"},{"code":"250","type":"RC"},{"code":"37826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Precision    Tes Xtra","code_information":[{"code":"CP17744631830812910","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599987705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Primaquine   Tab 26.3mg","code_information":[{"code":"CP17744631830834196","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385010201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":263,"type":"ME"}},{"description":"Trifluoperaz Tab 10mg","code_information":[{"code":"CP17744631831184648","type":"CDM"},{"code":"250","type":"RC"},{"code":"37824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828513953","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975027810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Carisoprodol Tab 250mg","code_information":[{"code":"CP17744631829133230","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clomipramine Cap 75mg","code_information":[{"code":"CP17744631829371005","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714085103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Colchicine   Cap 0.6mg","code_information":[{"code":"CP17744631829401574","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Cyanocobalam Inj 1000mcg","code_information":[{"code":"CP17744631829438309","type":"CDM"},{"code":"250","type":"RC"},{"code":"70512084025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Morphine Sul Tab 30mg Er","code_information":[{"code":"CP17744631830502329","type":"CDM"},{"code":"250","type":"RC"},{"code":"40683","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Naproxen Dr  Tab 500mg","code_information":[{"code":"CP17744631830541128","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494045410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nicotine Td  Dis 14mg/24h","code_information":[{"code":"CP17744631830566098","type":"CDM"},{"code":"250","type":"RC"},{"code":"53658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Nicotine Td  Dis 7mg/24hr","code_information":[{"code":"CP17744631830568651","type":"CDM"},{"code":"250","type":"RC"},{"code":"53658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Tacrolimus   Oin 0.03%","code_information":[{"code":"CP17744631831094610","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729042112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831092170","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729042210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Telmisa/hctz Tab 40-12.5","code_information":[{"code":"CP17744631831100028","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Telmisartan/hctz 40/12.5mg Tab","code_information":[{"code":"CP17744631831103421","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Doxycycl Hyc Cap 100mg","code_information":[{"code":"CP17744631829748353","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238110002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluocin Acet Oil Body","code_information":[{"code":"CP17744631829968239","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162070486","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluorouracil Cre 5%","code_information":[{"code":"CP17744631829975496","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672411806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lamotrigine  Tab 50mg Odt","code_information":[{"code":"CP17744631830215220","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918036030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Methylphenid Tab 27mg Er","code_information":[{"code":"CP17744631830454860","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811070710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":27,"type":"ME"}},{"description":"Methylpred   Tab 32mg","code_information":[{"code":"CP17744631830458900","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382091911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Olmesa Medox Tab 40mg","code_information":[{"code":"CP17744631830677953","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462043890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olmesa Medox Tab 40mg","code_information":[{"code":"CP17744631830673217","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862074330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830679437","type":"CDM"},{"code":"250","type":"RC"},{"code":"70512052005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paroxetine   Sus 10mg/5ml","code_information":[{"code":"CP17744631830736208","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954031910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pioglita/met Tab 15-500mg","code_information":[{"code":"CP17744631830778785","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Thyquidity   Sol 100mcg","code_information":[{"code":"CP17744631831125141","type":"CDM"},{"code":"250","type":"RC"},{"code":"52652195002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tramadol Hcl Tab 100mg Er","code_information":[{"code":"CP17744631831154807","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335053183","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tretinoin    Cre 0.025%","code_information":[{"code":"CP17744631831171703","type":"CDM"},{"code":"250","type":"RC"},{"code":"37880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Triazolam    Tab 0.125mg","code_information":[{"code":"CP17744631831187552","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710152101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ball Of Foot Cushion Gel","code_information":[{"code":"CP17744631828830298","type":"CDM"},{"code":"250","type":"RC"},{"code":"9629513356","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828993266","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180031906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cevimeline   Cap 30mg","code_information":[{"code":"CP17744631829209282","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571065710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Diphenhydram Liq 12.5/5ml","code_information":[{"code":"CP17744631829706677","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Diphenhydramine/gerilanta","code_information":[{"code":"CP17744631829700441","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diphenhydramine/gerilanta/lid","code_information":[{"code":"CP17744631829703242","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Geri-lanta/diphen 12.5/5","code_information":[{"code":"CP17744631830037210","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydromorphon Tab 2mg","code_information":[{"code":"CP17744631830118500","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858030101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Metronidazol Cre 0.75%","code_information":[{"code":"CP17744631830477151","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Olmesa Medox Tab 40mg","code_information":[{"code":"CP17744631830679542","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olmesa Medox Tab 40mg","code_information":[{"code":"CP17744631830673761","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olmesartan 40mg Tab","code_information":[{"code":"CP17744631830674950","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olmesartan Tab 40mg","code_information":[{"code":"CP17744631830671203","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sucralfate   Tab 1gm","code_information":[{"code":"CP17744631831079205","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033000301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831146344","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831145788","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762004701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831146461","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831148346","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762004702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831140180","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831146712","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762004802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831145259","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762004801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831146550","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668019030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831142510","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668019005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine Er 2mg Cap","code_information":[{"code":"CP17744631831150513","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tweezer Square Tip","code_information":[{"code":"CP17744631831201810","type":"CDM"},{"code":"250","type":"RC"},{"code":"1093918233","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromocriptin Cap 5mg","code_information":[{"code":"CP17744631828958476","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304015830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cefpodoxime  Tab 200mg","code_information":[{"code":"CP17744631829178038","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829233723","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314065610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829233040","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571012050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Dexmethylphe Cap 10mg Er","code_information":[{"code":"CP17744631829570989","type":"CDM"},{"code":"250","type":"RC"},{"code":"52781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dox/dex/nys/dip 500-6.000-50","code_information":[{"code":"CP17744631829733431","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304061650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxycyc Mono Cap 100mg","code_information":[{"code":"CP17744631829735429","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304061650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Durapore     Tap 2\"x10yds","code_information":[{"code":"CP17744631829767631","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333153802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Endocet      Tab 10-325mg","code_information":[{"code":"CP17744631829777535","type":"CDM"},{"code":"250","type":"RC"},{"code":"60951071270","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluocin Acet Cre 0.025%","code_information":[{"code":"CP17744631829964266","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565002015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hc Pramoxine 2.5-1% Cream","code_information":[{"code":"CP17744631830079081","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802047264","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hc Pramoxine Cre 2.5-1%","code_information":[{"code":"CP17744631830077030","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802047264","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Iv Secondary Set","code_information":[{"code":"CP17744631830170557","type":"CDM"},{"code":"250","type":"RC"},{"code":"23324","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidorx       Gel 3%","code_information":[{"code":"CP17744631830341549","type":"CDM"},{"code":"250","type":"RC"},{"code":"35781030001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Lubiprostone Cap 24mcg","code_information":[{"code":"CP17744631830388339","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710164206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Metaxalone   Tab 800mg","code_information":[{"code":"CP17744631830439682","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162055310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Metronidazol Gel 0.75%vag","code_information":[{"code":"CP17744631830473210","type":"CDM"},{"code":"250","type":"RC"},{"code":"73473030370","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Mucinex Dm   Tab 60-1200","code_information":[{"code":"CP17744631830514469","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824007235","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Ostomy Pouch 18364","code_information":[{"code":"CP17744631830696753","type":"CDM"},{"code":"250","type":"RC"},{"code":"56979","type":"CPT","modifier":"4"}],"standard_charges":[{"setting":"outpatient","modifier_code":["4"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Polyeth Glyc Pow 3350 Nf","code_information":[{"code":"CP17744631830787532","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784018010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Testosterone Gel 1.62%","code_information":[{"code":"CP17744631831111112","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Testosterone Gel 1.62%","code_information":[{"code":"CP17744631831117872","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979007815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831134823","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918060160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Amlod/atorva Tab 10-20mg","code_information":[{"code":"CP17744631828472545","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762673101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 10-20mg","code_information":[{"code":"CP17744631828473286","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505348403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 10-20mg","code_information":[{"code":"CP17744631828483052","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598031830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 10-80mg","code_information":[{"code":"CP17744631828481299","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762673301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 5-20mg","code_information":[{"code":"CP17744631828481933","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505348303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/atorva Tab 5-20mg","code_information":[{"code":"CP17744631828485126","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762672101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/atorva Tab 5-40mg","code_information":[{"code":"CP17744631828481043","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505348803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/atorva Tab 5-40mg","code_information":[{"code":"CP17744631828486512","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762672201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlodipine Bes/atorv 5/80mg Tb","code_information":[{"code":"CP17744631828491440","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762672301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlodipine-atorvast 10-40 Mg","code_information":[{"code":"CP17744631828493531","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762673201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Demeclocycl  Tab 150mg","code_information":[{"code":"CP17744631829559598","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162055410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Disopyramide Cap 150mg","code_information":[{"code":"CP17744631829712149","type":"CDM"},{"code":"250","type":"RC"},{"code":"93312","type":"CPT","modifier":"901"}],"standard_charges":[{"setting":"outpatient","modifier_code":["901"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fluorouracil Cre 5%","code_information":[{"code":"CP17744631829977107","type":"CDM"},{"code":"250","type":"RC"},{"code":"66530024940","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lorazepam    Tab 0.5mg","code_information":[{"code":"CP17744631830369327","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315090405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phenobarb    Tab 64.8mg","code_information":[{"code":"CP17744631830763460","type":"CDM"},{"code":"250","type":"RC"},{"code":"13517062701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":648,"type":"ME"}},{"description":"Riomet       Sol","code_information":[{"code":"CP17744631830895800","type":"CDM"},{"code":"250","type":"RC"},{"code":"10631020602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amiodarone   Tab 100mg","code_information":[{"code":"CP17744631828467572","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494030703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Attends Briefs Xxx-l","code_information":[{"code":"CP17744631828794258","type":"CDM"},{"code":"250","type":"RC"},{"code":"86679048375","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carbamazepin Cap 100mg Er","code_information":[{"code":"CP17744631829114423","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505280507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cevimeline   Cap 30mg","code_information":[{"code":"CP17744631829201299","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888011801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Chlorpromaz  Tab 50mg","code_information":[{"code":"CP17744631829215737","type":"CDM"},{"code":"250","type":"RC"},{"code":"78159","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cyclopentol  Sol 1% Op","code_information":[{"code":"CP17744631829440700","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478010012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dermotic     Oil 0.01%","code_information":[{"code":"CP17744631829558809","type":"CDM"},{"code":"250","type":"RC"},{"code":"68791010320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eplerenone   Tab 25mg","code_information":[{"code":"CP17744631829794605","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762171003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Finasteride  Tab 5mg","code_information":[{"code":"CP17744631829955976","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722052590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hc Valerate  Oin 0.2%","code_information":[{"code":"CP17744631830072831","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Iv Primary Tubing 81","code_information":[{"code":"CP17744631830174146","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"721","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":1,"discounted_cash":1}]},{"description":"Labetalol    Tab 300mg","code_information":[{"code":"CP17744631830206712","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135071301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lactulose    Sol 10gm/15","code_information":[{"code":"CP17744631830208620","type":"CDM"},{"code":"250","type":"RC"},{"code":"12145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Lidocaine    Pad 5%","code_information":[{"code":"CP17744631830332620","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714017730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylphenid Tab 18mg Er","code_information":[{"code":"CP17744631830457380","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811070610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":18,"type":"ME"}},{"description":"Pancreaze    Cap 4200unit","code_information":[{"code":"CP17744631830734364","type":"CDM"},{"code":"250","type":"RC"},{"code":"62541040210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4200,"type":"UN"}},{"description":"Silodosin    Cap 4mg","code_information":[{"code":"CP17744631831016691","type":"CDM"},{"code":"250","type":"RC"},{"code":"78126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tiagabine    Tab 4mg","code_information":[{"code":"CP17744631831122187","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756022483","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831148840","type":"CDM"},{"code":"250","type":"RC"},{"code":"93716","type":"CPT","modifier":"405"}],"standard_charges":[{"setting":"outpatient","modifier_code":["405"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Triamcinolon Aer Spray","code_information":[{"code":"CP17744631831173188","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802004501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Unisom       Tab 25mg","code_information":[{"code":"CP17744631831208483","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167000607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831254505","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052899","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831259323","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831267575","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine Er 75mg Caps","code_information":[{"code":"CP17744631831266524","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052899","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cholestyram  Pow 4gm Lite","code_information":[{"code":"CP17744631829220156","type":"CDM"},{"code":"250","type":"RC"},{"code":"18509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829265261","type":"CDM"},{"code":"250","type":"RC"},{"code":"16801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Gel 0.05%","code_information":[{"code":"CP17744631829260546","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Gel 0.05%","code_information":[{"code":"CP17744631829265850","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Gel 0.05%","code_information":[{"code":"CP17744631829263628","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565008260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Gel 0.05%","code_information":[{"code":"CP17744631829264909","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565008230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol 0.05% Gel","code_information":[{"code":"CP17744631829368539","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Diltiazem Er Tab 240mg","code_information":[{"code":"CP17744631829700912","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Disopyramide Cap 150mg","code_information":[{"code":"CP17744631829719005","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862009601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Itraconazole Cap 100mg","code_information":[{"code":"CP17744631830163560","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lactinex     Gra","code_information":[{"code":"CP17744631830205326","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290236712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metolazone   Tab 10mg","code_information":[{"code":"CP17744631830456454","type":"CDM"},{"code":"250","type":"RC"},{"code":"37861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Metronidazol Gel 0.75%vag","code_information":[{"code":"CP17744631830474499","type":"CDM"},{"code":"250","type":"RC"},{"code":"78170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Nicotine Td  Dis 21mg/24h","code_information":[{"code":"CP17744631830563599","type":"CDM"},{"code":"250","type":"RC"},{"code":"53658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Ritonavir    Tab 100mg","code_information":[{"code":"CP17744631830900372","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862068730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Salonpas     Pad Hot","code_information":[{"code":"CP17744631830995047","type":"CDM"},{"code":"250","type":"RC"},{"code":"46581087106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Varenicline  Pak 0.5x1mg","code_information":[{"code":"CP17744631831246610","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884094499","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Varenicline  Tab 0.5& 1mg","code_information":[{"code":"CP17744631831244821","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884094499","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Varenicline  Tab 0.5mg","code_information":[{"code":"CP17744631831247756","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462089356","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zolpidem     Tab 5mg","code_information":[{"code":"CP17744631831404790","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Candesa/hctz Tab 32-25mg","code_information":[{"code":"CP17744631829097640","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559066290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Candesartan  Tab 16mg","code_information":[{"code":"CP17744631829094792","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332034330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Celecoxib    Cap 100mg","code_information":[{"code":"CP17744631829181963","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Celecoxib 100mg Caps","code_information":[{"code":"CP17744631829199355","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829262336","type":"CDM"},{"code":"250","type":"RC"},{"code":"16801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829269057","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672125906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Diltiazem    Cap 360mg Er","code_information":[{"code":"CP17744631829690856","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979003007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Epinephrine  Inj 1mg/10ml","code_information":[{"code":"CP17744631829796241","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829988240","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714067401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829984705","type":"CDM"},{"code":"250","type":"RC"},{"code":"52717","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829984508","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829983975","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241025301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829980034","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954027510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829988587","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710149001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829983044","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829982384","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238168001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829987471","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954027520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829983231","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714000401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluphenazine Tab 5mg","code_information":[{"code":"CP17744631829981232","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714067402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Iv Primary Tubing","code_information":[{"code":"CP17744631830172959","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"921","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":1,"discounted_cash":1}]},{"description":"Lypo-spheric Vit C 1000mg","code_information":[{"code":"CP17744631830387894","type":"CDM"},{"code":"250","type":"RC"},{"code":"85851400185","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Morphine Sul Tab 100mg Er","code_information":[{"code":"CP17744631830509788","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304045201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Morphine Sul Tab 100mg Er","code_information":[{"code":"CP17744631830509417","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862018801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Morphine Sul Tab 100mg Er","code_information":[{"code":"CP17744631830505088","type":"CDM"},{"code":"250","type":"RC"},{"code":"40683","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Morphine Sul Tab 100mg Er","code_information":[{"code":"CP17744631830506706","type":"CDM"},{"code":"250","type":"RC"},{"code":"22843","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Niacin Er    Tab 1000mg","code_information":[{"code":"CP17744631830558094","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175032246","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Niacin Er    Tab 1000mg","code_information":[{"code":"CP17744631830552998","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162032309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Nicotine Td  Dis 21mg/24h","code_information":[{"code":"CP17744631830564327","type":"CDM"},{"code":"250","type":"RC"},{"code":"53658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Nifedipine   Tab 60mg Er","code_information":[{"code":"CP17744631830567679","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742026101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Old Iv Primary Tubing","code_information":[{"code":"CP17744631830677989","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"921","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":1,"discounted_cash":1}]},{"description":"Old Iv Primary Tubing--kit","code_information":[{"code":"CP17744631830679395","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"921","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":1,"discounted_cash":1}]},{"description":"Olmesartan 40mg Tabs","code_information":[{"code":"CP17744631830678004","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877044790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Orphenadrine Tab 100mg Er","code_information":[{"code":"CP17744631830698088","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386048024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Renvela      Tab 800mg","code_information":[{"code":"CP17744631830883799","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelam Carb Tab 800mg","code_information":[{"code":"CP17744631831000365","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831014517","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb 800mg Tabs","code_information":[{"code":"CP17744631831011669","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb 800mg Tb (Renv)","code_information":[{"code":"CP17744631831010540","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb Tab 800mg","code_information":[{"code":"CP17744631831014544","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb. 800mg Tab","code_information":[{"code":"CP17744631831014260","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Tiadylt      Cap 300mg/24","code_information":[{"code":"CP17744631831129691","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382074816","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Toprol Xl    Tab 25mg","code_information":[{"code":"CP17744631831158431","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842011002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Toprol Xl    Tab 50mg","code_information":[{"code":"CP17744631831155269","type":"CDM"},{"code":"250","type":"RC"},{"code":"70842011102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Acyclovir 580mg/100mlns","code_information":[{"code":"CP17744631828337595","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":580,"type":"ME"}},{"description":"Acyclovir 800mg/ Ns 0.9% 250m","code_information":[{"code":"CP17744631828344392","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Acyclovir675mg/250ml Ns","code_information":[{"code":"CP17744631828343052","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323032520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":675,"type":"ME"}},{"description":"Atropine Sul Inj 0.1mg/ml","code_information":[{"code":"CP17744631828799689","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ciclopirox   Sol 8%","code_information":[{"code":"CP17744631829223522","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383041906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Clobazam     Sus 2.5mg/ml","code_information":[{"code":"CP17744631829253372","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238153502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Doxepin      Tab 6mg","code_information":[{"code":"CP17744631829736796","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135076430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Doxycyc Mono Tab 150mg","code_information":[{"code":"CP17744631829749737","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710112403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Doxycycline  Tab 150mg","code_information":[{"code":"CP17744631829744687","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710112403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Erythrom Eth Sus 200/5ml","code_information":[{"code":"CP17744631829802905","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559044001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Foley Catheter 18fr","code_information":[{"code":"CP17744631829995184","type":"CDM"},{"code":"250","type":"RC"},{"code":"11520","type":"CPT","modifier":"78"}],"standard_charges":[{"setting":"outpatient","modifier_code":["78"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydralazine  Tab 25mg","code_information":[{"code":"CP17744631830092799","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111032701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydrea       Cap 500mg","code_information":[{"code":"CP17744631830097941","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269083510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Isradipine   Cap 2.5mg","code_information":[{"code":"CP17744631830169108","type":"CDM"},{"code":"250","type":"RC"},{"code":"16252053901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lidocaine    Gel 2% Jelly","code_information":[{"code":"CP17744631830338590","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lorazepam    Inj 2mg/ml","code_information":[{"code":"CP17744631830369936","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lubricant Pm Oin","code_information":[{"code":"CP17744631830389814","type":"CDM"},{"code":"250","type":"RC"},{"code":"71406012435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mercaptopur  Tab 50mg","code_information":[{"code":"CP17744631830426245","type":"CDM"},{"code":"250","type":"RC"},{"code":"54458","type":"CPT","modifier":"127"}],"standard_charges":[{"setting":"outpatient","modifier_code":["127"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Mesalamine   Cap 400mg Dr","code_information":[{"code":"CP17744631830439630","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762011701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Methylpr Ss  Inj 125mg","code_information":[{"code":"CP17744631830454940","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598012901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Mycophenolic Tab 360mg Dr","code_information":[{"code":"CP17744631830526894","type":"CDM"},{"code":"250","type":"RC"},{"code":"37842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Mycophenolic Tab 360mg Dr","code_information":[{"code":"CP17744631830525831","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436017323","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Mycophenolic Tab 360mg Dr","code_information":[{"code":"CP17744631830521341","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729018929","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Mycophenolic Tab 360mg Dr","code_information":[{"code":"CP17744631830522251","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377004011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Mycophenolic Tab 360mg Dr","code_information":[{"code":"CP17744631830528307","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979016144","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Mycophenolic Tab 360mg Dr","code_information":[{"code":"CP17744631830520373","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505296607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Nicotine Td  Dis 7mg/24hr","code_information":[{"code":"CP17744631830561754","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598044670","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Oxycodone    Tab 10mg","code_information":[{"code":"CP17744631830711196","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycodone 10mg Tabs","code_information":[{"code":"CP17744631830715056","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Polyeth Glyc Pow 3350 Nf","code_information":[{"code":"CP17744631830786923","type":"CDM"},{"code":"250","type":"RC"},{"code":"69784018030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prednisone   Tab 2.5mg","code_information":[{"code":"CP17744631830813108","type":"CDM"},{"code":"250","type":"RC"},{"code":"54474","type":"CPT","modifier":"225"}],"standard_charges":[{"setting":"outpatient","modifier_code":["225"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Uro-mp       Cap 118mg","code_information":[{"code":"CP17744631831218257","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657045601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":118,"type":"ME"}},{"description":"Cefprozil    Tab 500mg","code_information":[{"code":"CP17744631829177214","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237003750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefprozil    Tab 500mg","code_information":[{"code":"CP17744631829174215","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714039901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cimetidine   Tab 400mg","code_information":[{"code":"CP17744631829239748","type":"CDM"},{"code":"250","type":"RC"},{"code":"93820","type":"CPT","modifier":"405"}],"standard_charges":[{"setting":"outpatient","modifier_code":["405"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Desmopressin Tab 0.1mg","code_information":[{"code":"CP17744631829560041","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505025701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dexmethylphe Cap 10mg Er","code_information":[{"code":"CP17744631829572327","type":"CDM"},{"code":"250","type":"RC"},{"code":"93555","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Heparin Lock Inj 100/ml","code_information":[{"code":"CP17744631830077783","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290306424","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Isosorb Mono Tab 30mg Er","code_information":[{"code":"CP17744631830163222","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668010410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Mesalamine   Cap 0.375gm","code_information":[{"code":"CP17744631830432496","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382045219","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Salonpas 10-3% Patch","code_information":[{"code":"CP17744631830995411","type":"CDM"},{"code":"250","type":"RC"},{"code":"34658167509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Terconazole  Cre 0.8%","code_information":[{"code":"CP17744631831117426","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Triamcinolon Aer Spray","code_information":[{"code":"CP17744631831171792","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980042901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinolon Aer Spray","code_information":[{"code":"CP17744631831178329","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980042963","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zarontin     Cap 250mg","code_information":[{"code":"CP17744631831390299","type":"CDM"},{"code":"250","type":"RC"},{"code":"71023","type":"CPT","modifier":"724"}],"standard_charges":[{"setting":"outpatient","modifier_code":["724"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Arformoterol Neb 15/2ml","code_information":[{"code":"CP17744631828744647","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436015157","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Bisoprol Fum Tab 10mg","code_information":[{"code":"CP17744631828939505","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954045620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cimetidine   Tab 800mg","code_information":[{"code":"CP17744631829232518","type":"CDM"},{"code":"250","type":"RC"},{"code":"37805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Clonazepam   Tab 1mg","code_information":[{"code":"CP17744631829372445","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651072301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Cyclophosph  Cap 50mg","code_information":[{"code":"CP17744631829444850","type":"CDM"},{"code":"250","type":"RC"},{"code":"54879002201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Disopyramide Cap 100mg","code_information":[{"code":"CP17744631829706350","type":"CDM"},{"code":"250","type":"RC"},{"code":"93312","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829818684","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304073430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829815688","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304073490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829812462","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377005512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829810721","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462039090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829813119","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462039130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829813965","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304073530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829818512","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598051090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829811822","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377005612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829816825","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598051030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ketotif Fum  Dro","code_information":[{"code":"CP17744631830199553","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385010617","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketotifen Fu Sol 0.025%","code_information":[{"code":"CP17744631830193005","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485061710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Ketotifen Fu Sol 0.035%","code_information":[{"code":"CP17744631830197169","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485061710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":35,"type":"EA"}},{"description":"Silodosin    Cap 4mg","code_information":[{"code":"CP17744631831012860","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241014401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Silodosin    Cap 4mg","code_information":[{"code":"CP17744631831018034","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238142103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Silodosin    Cap 8mg","code_information":[{"code":"CP17744631831014439","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238142003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Silodosin    Cap 8mg","code_information":[{"code":"CP17744631831018792","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238142009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Trimethoprim Tab 100mg","code_information":[{"code":"CP17744631831191657","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862048601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Acetic Acid  Sol 2% Otic","code_information":[{"code":"CP17744631828261847","type":"CDM"},{"code":"250","type":"RC"},{"code":"60432074115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Cefuroxime   Tab 500mg","code_information":[{"code":"CP17744631829183898","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefuroxime 500mg Tabs","code_information":[{"code":"CP17744631829180699","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Chlorzoxazon Tab 375mg","code_information":[{"code":"CP17744631829226831","type":"CDM"},{"code":"250","type":"RC"},{"code":"25420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Codeine Sulf Tab 60mg","code_information":[{"code":"CP17744631829406591","type":"CDM"},{"code":"250","type":"RC"},{"code":"54024","type":"CPT","modifier":"525"}],"standard_charges":[{"setting":"outpatient","modifier_code":["525"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Dabigatran   Cap 110mg","code_information":[{"code":"CP17744631829452997","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":110,"type":"ME"}},{"description":"Dabigatran   Cap 150mg","code_information":[{"code":"CP17744631829469495","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Dabigatran   Cap 75mg","code_information":[{"code":"CP17744631829462801","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205020260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Fluocin Acet Oin 0.025%","code_information":[{"code":"CP17744631829969885","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydroxychlor Tab 400mg","code_information":[{"code":"CP17744631830115820","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729056301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Lamotrigine  Tab 25mg Odt","code_information":[{"code":"CP17744631830214043","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918035030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830333991","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830333200","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380078932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Nicotine Sys Kit Transder","code_information":[{"code":"CP17744631830554674","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598044556","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830712440","type":"CDM"},{"code":"250","type":"RC"},{"code":"40605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Propranolol  Cap 120mg Er","code_information":[{"code":"CP17744631830840562","type":"CDM"},{"code":"250","type":"RC"},{"code":"52741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Risperidone   Tab 2mg Odt","code_information":[{"code":"CP17744631830908054","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746003022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Risperidone  Tab 2mg Odt","code_information":[{"code":"CP17744631830900262","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746003022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Risperidone Odt-2mg","code_information":[{"code":"CP17744631830904420","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746003022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Rosuvastatin 10mg Tabs","code_information":[{"code":"CP17744631830916537","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862029490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin 5mg Tabs","code_information":[{"code":"CP17744631830916276","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729028415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830917215","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237016999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830922745","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830926172","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377000712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830926169","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830929754","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722088390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830923789","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830924830","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237016990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830922707","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462026290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830925584","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862029490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830922587","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377000812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830925880","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830928814","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462026390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830929782","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830922833","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862029590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830920732","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722088490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830926931","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205000499","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 20mg","code_information":[{"code":"CP17744631830921578","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808015701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830926437","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462026430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830926518","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729028710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830926515","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722088530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830923010","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862029630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830925546","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808015803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830927977","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377000913","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab 40mg","code_information":[{"code":"CP17744631830920260","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729028715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830927040","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668017990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830921943","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335058281","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830927246","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237016890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830928665","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722088290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830929355","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862029390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830928690","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377000612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830925411","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228011610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Senna/dss    Tab 8.6-50mg","code_information":[{"code":"CP17744631831009060","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687062201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":86,"type":"ME"}},{"description":"Silodosin    Cap 4mg","code_information":[{"code":"CP17744631831011892","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342038407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Silodosin    Cap 8mg","code_information":[{"code":"CP17744631831019726","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342038507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ziprasidone  Cap 40mg","code_information":[{"code":"CP17744631831401257","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505252906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Arginaid     Pak Cherry","code_information":[{"code":"CP17744631828746117","type":"CDM"},{"code":"250","type":"RC"},{"code":"43900035988","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Beta Diprop  Gel 0.05%","code_information":[{"code":"CP17744631828864630","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Betamethasone Dip Aug 0.05%gel","code_information":[{"code":"CP17744631828871399","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Calcipotrien Oin 0.005%","code_information":[{"code":"CP17744631829066702","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462031065","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829245248","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547068810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829260538","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexameth Pho Inj 4mg/ml","code_information":[{"code":"CP17744631829572697","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150023701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Dofetilide   Cap 500mcg","code_information":[{"code":"CP17744631829729494","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603013201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ery/benzoyl  Gel 5-3%","code_information":[{"code":"CP17744631829806575","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980032801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829818686","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714097901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829816565","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Levalbutero Neb 1.25/0.5 30ml","code_information":[{"code":"CP17744631830294190","type":"CDM"},{"code":"250","type":"RC"},{"code":"93414","type":"CPT","modifier":"756"}],"standard_charges":[{"setting":"outpatient","modifier_code":["756"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Levalbuterol Neb 1.25/0.5","code_information":[{"code":"CP17744631830294904","type":"CDM"},{"code":"250","type":"RC"},{"code":"93414","type":"CPT","modifier":"756"}],"standard_charges":[{"setting":"outpatient","modifier_code":["756"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Lido-hydro   Gel 2.8-0.55","code_information":[{"code":"CP17744631830343106","type":"CDM"},{"code":"250","type":"RC"},{"code":"59088081701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":28,"type":"EA"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830536242","type":"CDM"},{"code":"250","type":"RC"},{"code":"90470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nifedipine   Tab 60mg Er","code_information":[{"code":"CP17744631830568271","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682010910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830814419","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722061390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830815467","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722061490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 300mg","code_information":[{"code":"CP17744631830824256","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722061790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pregabalin   Cap 50mg","code_information":[{"code":"CP17744631830829162","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722061190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830826103","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722061290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pregabalin-300mg-caps","code_information":[{"code":"CP17744631830824271","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722061790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 50mg Er","code_information":[{"code":"CP17744631830869900","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180061207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Quetiapine   Tab 50mg Er","code_information":[{"code":"CP17744631830866967","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729013212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Risedronate  Tab 5mg","code_information":[{"code":"CP17744631830892170","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342010707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ropinirole   Tab 0.5mg","code_information":[{"code":"CP17744631830912575","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547026910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ropinirole 0.5mg Tabs","code_information":[{"code":"CP17744631830917322","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547026910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831097607","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714009901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ziprasidone  Cap 20mg","code_information":[{"code":"CP17744631831407499","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111025660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ziprasidone  Cap 20mg","code_information":[{"code":"CP17744631831405415","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714083501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ziprasidone  Cap 40mg","code_information":[{"code":"CP17744631831403575","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714083601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Ziprasidone 20mg Caps","code_information":[{"code":"CP17744631831408119","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ziprasidone 20mg Caps","code_information":[{"code":"CP17744631831405681","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714083501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ziprasidone 40mg Caps","code_information":[{"code":"CP17744631831404673","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Allegra-d    Tab 24 Hour","code_information":[{"code":"CP17744631828413814","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167432007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupren/nalox  8-2mg  Film","code_information":[{"code":"CP17744631828975394","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Mis 8-2mg","code_information":[{"code":"CP17744631828977964","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Bupren/nalox Sub 8-2mg Film","code_information":[{"code":"CP17744631828979629","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Buprenorp-nalox 8-2 Mg Sl Film","code_information":[{"code":"CP17744631828987691","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Calcipotrien Cre 0.005%","code_information":[{"code":"CP17744631829062879","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Closed Pouch Mis 2-3/4\"","code_information":[{"code":"CP17744631829385431","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010345","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxercalcif  Inj 4mcg/2ml","code_information":[{"code":"CP17744631829737646","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288080204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829965826","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829962119","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462010230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gonak Op     Sol 2.5%","code_information":[{"code":"CP17744631830050421","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478006412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Isosorb Mono Tab 120mg Er","code_information":[{"code":"CP17744631830168562","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742017701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Isosorb Mono Tab 120mg Er","code_information":[{"code":"CP17744631830168098","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155062801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Isosorb Mono Tab 120mg Er","code_information":[{"code":"CP17744631830165124","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799096001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Iv Secondary Set","code_information":[{"code":"CP17744631830174164","type":"CDM"},{"code":"250","type":"RC"},{"code":"85412049064","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketorolac    Inj 30mg/ml","code_information":[{"code":"CP17744631830198902","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lorazepam    Tab 1mg","code_information":[{"code":"CP17744631830367657","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107008401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Mask & Nebulizer Kit Adul","code_information":[{"code":"CP17744631830400779","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/dex Sus 0.1% Op","code_information":[{"code":"CP17744631830540564","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nozin Nasal Sanitizer","code_information":[{"code":"CP17744631830640492","type":"CDM"},{"code":"250","type":"RC"},{"code":"56923001117","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olopatadine  Dro 0.1% Op","code_information":[{"code":"CP17744631830675444","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122067264","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxycod/apap  Tab 2.5-325","code_information":[{"code":"CP17744631830712145","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702018401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Poise        Pad Maximum","code_information":[{"code":"CP17744631830780558","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000033591","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prednisolone Sol 15mg/5ml","code_information":[{"code":"CP17744631830818562","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135025037","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Tacrolimus   Oin 0.03%","code_information":[{"code":"CP17744631831090203","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462088165","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Tiagabine    Tab 2mg","code_information":[{"code":"CP17744631831127101","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205008430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Varenicline  Tab 0.5mg","code_information":[{"code":"CP17744631831243690","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884015576","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Varenicline  Tab 0.5mg","code_information":[{"code":"CP17744631831241895","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877074395","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Varenicline  Tab 1mg","code_information":[{"code":"CP17744631831247238","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748012849","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Varenicline  Tab 1mg","code_information":[{"code":"CP17744631831243773","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877074495","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Varenicline  Tab 1mg","code_information":[{"code":"CP17744631831243667","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884015676","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"10ml Ll Syrn Mis 21gx1\"","code_information":[{"code":"CP17744631828064743","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290309642","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828519652","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975028010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ceftriaxone  Inj 1gm","code_information":[{"code":"CP17744631829187249","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Dofetilide   Cap 125mcg","code_information":[{"code":"CP17744631829716966","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Dofetilide   Cap 125mcg","code_information":[{"code":"CP17744631829721521","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603013001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829725955","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dofetilide   Cap 500mcg","code_information":[{"code":"CP17744631829723936","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Donepezil    Tab 23mg","code_information":[{"code":"CP17744631829720996","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979000407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":23,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829818628","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377005613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829968709","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829961744","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111014430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829961832","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710113803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluvastatin  Tab 80mg Er","code_information":[{"code":"CP17744631829983954","type":"CDM"},{"code":"250","type":"RC"},{"code":"52725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Glycopyrrol  Tab 1mg","code_information":[{"code":"CP17744631830053043","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571074309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ketoconazole Cre 2%","code_information":[{"code":"CP17744631830184738","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Konvomep     Sus 2-84/ml","code_information":[{"code":"CP17744631830197048","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628027210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lanthanum    Chw 750mg","code_information":[{"code":"CP17744631830217607","type":"CDM"},{"code":"250","type":"RC"},{"code":"76282047790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830483741","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830480416","type":"CDM"},{"code":"250","type":"RC"},{"code":"82293000510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olm Med/hctz Tab 20-12.5","code_information":[{"code":"CP17744631830672260","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756081290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Olm Med/hctz Tab 40-12.5","code_information":[{"code":"CP17744631830673033","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756081390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Olm Med/hctz Tab 40-25mg","code_information":[{"code":"CP17744631830674896","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332015190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olm Med/hctz Tab 40-25mg","code_information":[{"code":"CP17744631830671915","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332015130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olm Med/hctz Tab 40-25mg","code_information":[{"code":"CP17744631830677284","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862078190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olmesa Medox Tab 40mg","code_information":[{"code":"CP17744631830672660","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332013330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Olmesa Medox Tab 40mg","code_information":[{"code":"CP17744631830674489","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668025030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pentazoc/nalox Hcl 5-0.5mg Tab","code_information":[{"code":"CP17744631830741250","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386068001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Prochlorper  Tab 10mg","code_information":[{"code":"CP17744631830833699","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746011506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Syr+ndl Bd 10ml 21gx1\"","code_information":[{"code":"CP17744631831084497","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290309642","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Syr+ndl Bd 10ml 21gx1ml","code_information":[{"code":"CP17744631831083793","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290309642","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831149175","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436016106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Toprol Xl    Tab 25mg","code_information":[{"code":"CP17744631831153788","type":"CDM"},{"code":"250","type":"RC"},{"code":"70347002502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amphetamine  Tab 10mg","code_information":[{"code":"CP17744631828523075","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010004101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"But/apap/caf Tab","code_information":[{"code":"CP17744631829041785","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687067265","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calcipotrien Cre 0.005%","code_information":[{"code":"CP17744631829065884","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714076301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cipro (5%)   Sus 250mg/5","code_information":[{"code":"CP17744631829232675","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419077701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cipro 5gm/100ml Susp","code_information":[{"code":"CP17744631829236826","type":"CDM"},{"code":"250","type":"RC"},{"code":"50419077701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Clobazam     Sus 2.5mg/ml","code_information":[{"code":"CP17744631829255110","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877065861","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clobazam     Sus 2.5mg/ml","code_information":[{"code":"CP17744631829250019","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651040112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829262593","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700010617","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829266860","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291007760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829265450","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672125902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829268432","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672125903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829268409","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700010616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829260062","type":"CDM"},{"code":"250","type":"RC"},{"code":"16801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829267652","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383026860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desvenlafax  Tab 50mg Er","code_information":[{"code":"CP17744631829574207","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Disulfiram   Tab 250mg","code_information":[{"code":"CP17744631829711786","type":"CDM"},{"code":"250","type":"RC"},{"code":"54035","type":"CPT","modifier":"613"}],"standard_charges":[{"setting":"outpatient","modifier_code":["613"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Erythrom Eth Sus 400/5ml","code_information":[{"code":"CP17744631829809980","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238150402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fluocin Acet Cre 0.01%","code_information":[{"code":"CP17744631829969598","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrogel Dressing 2x2","code_information":[{"code":"CP17744631830118681","type":"CDM"},{"code":"250","type":"RC"},{"code":"61530","type":"CPT","modifier":"22"}],"standard_charges":[{"setting":"outpatient","modifier_code":["22"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Insyte Cath 20gx1","code_information":[{"code":"CP17744631830178961","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methenam Man Tab 500mg","code_information":[{"code":"CP17744631830445138","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799010501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Methotrexate 50mg/2ml Pf","code_information":[{"code":"CP17744631830440457","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Methotrexate Inj 50mg/2ml","code_information":[{"code":"CP17744631830447412","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830533348","type":"CDM"},{"code":"250","type":"RC"},{"code":"40611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Naltrexone 4mg Capsules","code_information":[{"code":"CP17744631830537154","type":"CDM"},{"code":"250","type":"RC"},{"code":"40611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nebulizer Tubing","code_information":[{"code":"CP17744631830547923","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Protopic/bactroban/cetaphil","code_information":[{"code":"CP17744631830859423","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462053465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacro/ceta","code_information":[{"code":"CP17744631831095751","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462053465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831092305","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462053465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831096864","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462053435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus / Cetaphil Cream","code_information":[{"code":"CP17744631831094107","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462053465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Urea Hydrati Aer 35%","code_information":[{"code":"CP17744631831213211","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192011515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":35,"type":"EA"}},{"description":"Amlod/benazp Cap 5-20mg","code_information":[{"code":"CP17744631828487243","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180045901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Carnitor     Tab 330mg","code_information":[{"code":"CP17744631829133918","type":"CDM"},{"code":"250","type":"RC"},{"code":"54482014407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Closed Pouch Mis 1-3/4\"","code_information":[{"code":"CP17744631829385751","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380018362","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexameth Pho Inj 10mg/ml","code_information":[{"code":"CP17744631829579751","type":"CDM"},{"code":"250","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dexamethasone 6mg In 50ml Ns","code_information":[{"code":"CP17744631829575721","type":"CDM"},{"code":"250","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Diltiazem    Tab 90mg","code_information":[{"code":"CP17744631829690996","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228048301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Dutast/tamsu Cap 0.5-0.4","code_information":[{"code":"CP17744631829768467","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370028009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Galantamine  Cap 16mg Er","code_information":[{"code":"CP17744631830017957","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862074530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Hc Butyrate  Cre 0.1%","code_information":[{"code":"CP17744631830073352","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672407406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Admin Set / Flow Regul","code_information":[{"code":"CP17744631830176031","type":"CDM"},{"code":"250","type":"RC"},{"code":"85078","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Set W/flow Regulator","code_information":[{"code":"CP17744631830173145","type":"CDM"},{"code":"250","type":"RC"},{"code":"85078","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rosuvastatin Tab 10mg","code_information":[{"code":"CP17744631830929348","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877044090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rosuvastatin Tab 5mg","code_information":[{"code":"CP17744631830927393","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Spironolacto Sus 25mg/5ml","code_information":[{"code":"CP17744631831063527","type":"CDM"},{"code":"250","type":"RC"},{"code":"57411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Timolol Mal  Sol 0.25% Op","code_information":[{"code":"CP17744631831132632","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314022605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Amiodarone   Inj 50mg/ml","code_information":[{"code":"CP17744631828461564","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ampicillin2gm/100ml","code_information":[{"code":"CP17744631828526764","type":"CDM"},{"code":"250","type":"RC"},{"code":"72485042201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"GR"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829261568","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238153203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829267247","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291007615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829264047","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672125802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829266277","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cloth Adhesv Tap 2\"x10yds","code_information":[{"code":"CP17744631829381734","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333295002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dofetilide   Cap 125mcg","code_information":[{"code":"CP17744631829719583","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291041160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Dofetilide   Cap 125mcg","code_information":[{"code":"CP17744631829719481","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794004410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Dofetilide   Cap 125mcg","code_information":[{"code":"CP17744631829724992","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335006186","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829721097","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335006286","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829724917","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291041260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829720427","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794004510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829816792","type":"CDM"},{"code":"250","type":"RC"},{"code":"93645","type":"CPT","modifier":"56"}],"standard_charges":[{"setting":"outpatient","modifier_code":["56"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829818200","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829811445","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722057290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829816677","type":"CDM"},{"code":"250","type":"RC"},{"code":"93645","type":"CPT","modifier":"98"}],"standard_charges":[{"setting":"outpatient","modifier_code":["98"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829814764","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722057210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829813688","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829815428","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722057230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829812273","type":"CDM"},{"code":"250","type":"RC"},{"code":"93645","type":"CPT","modifier":"156"}],"standard_charges":[{"setting":"outpatient","modifier_code":["156"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829811821","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722057390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829819530","type":"CDM"},{"code":"250","type":"RC"},{"code":"93645","type":"CPT","modifier":"198"}],"standard_charges":[{"setting":"outpatient","modifier_code":["198"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomepra Mag Cap 40mg Dr","code_information":[{"code":"CP17744631829817699","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomeprazole 40mg Caps","code_information":[{"code":"CP17744631829816376","type":"CDM"},{"code":"250","type":"RC"},{"code":"93645","type":"CPT","modifier":"198"}],"standard_charges":[{"setting":"outpatient","modifier_code":["198"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Esomeprazole 40mg Caps","code_information":[{"code":"CP17744631829812864","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Icy Hot Adv  Pad Rlf 7.5%","code_information":[{"code":"CP17744631830132052","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167008050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Liquid I.v. Strawberry","code_information":[{"code":"CP17744631830340292","type":"CDM"},{"code":"250","type":"RC"},{"code":"85174100894","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Misoprostol  Tab 200mcg","code_information":[{"code":"CP17744631830491004","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954044410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nexium 20mg/10ml","code_information":[{"code":"CP17744631830558430","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sulfamylon   Cre 85mg/gm","code_information":[{"code":"CP17744631831073066","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571072360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":85,"type":"ME"}},{"description":"Sulfasalazin Tab 500mg","code_information":[{"code":"CP17744631831074841","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762500006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Systane Comp Sol Pf 0.6%","code_information":[{"code":"CP17744631831094860","type":"CDM"},{"code":"250","type":"RC"},{"code":"65150","type":"CPT","modifier":"928"}],"standard_charges":[{"setting":"outpatient","modifier_code":["928"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Systane Complete Pf","code_information":[{"code":"CP17744631831093811","type":"CDM"},{"code":"250","type":"RC"},{"code":"30065150928","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Telfa Adhesive Dressing 4 X 5","code_information":[{"code":"CP17744631831105719","type":"CDM"},{"code":"250","type":"RC"},{"code":"84521002692","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tretinoin    Cre 0.1%","code_information":[{"code":"CP17744631831174579","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714025001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alclometason Oin 0.05%","code_information":[{"code":"CP17744631828392212","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Amiodarone   Tab 400mg","code_information":[{"code":"CP17744631828470321","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672405706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828958647","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335063249","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Buprenorphin Sub 8mg","code_information":[{"code":"CP17744631828986130","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383093093","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Captopril    Tab 50mg","code_information":[{"code":"CP17744631829106739","type":"CDM"},{"code":"250","type":"RC"},{"code":"14311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cefpodoxime  Tab 200mg","code_information":[{"code":"CP17744631829170127","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714039501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Clarithromyc Sus 250/5ml","code_information":[{"code":"CP17744631829243275","type":"CDM"},{"code":"250","type":"RC"},{"code":"78160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Clobetasol   Lot 0.05%","code_information":[{"code":"CP17744631829261544","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672135008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dextroamphet Sol 5mg/5ml","code_information":[{"code":"CP17744631829581883","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808008501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830337034","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162091838","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Liothyronine Tab 50mcg","code_information":[{"code":"CP17744631830345092","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762120801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lisinop/hctz Tab 20-12.5","code_information":[{"code":"CP17744631830343157","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180051901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Morphine Sul Tab 60mg Er","code_information":[{"code":"CP17744631830502862","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862018701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Nebulizer K Tubing&mouth Piece","code_information":[{"code":"CP17744631830543908","type":"CDM"},{"code":"250","type":"RC"},{"code":"82238311650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Niacin       Tab 500mg Er","code_information":[{"code":"CP17744631830550414","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651001890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nicotine Td  Dis 7mg/24hr","code_information":[{"code":"CP17744631830560438","type":"CDM"},{"code":"250","type":"RC"},{"code":"53658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":7,"type":"ME"}},{"description":"Paroxetine   Tab 30mg","code_information":[{"code":"CP17744631830733083","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Phosphorus   Pow Suppleme","code_information":[{"code":"CP17744631830763805","type":"CDM"},{"code":"250","type":"RC"},{"code":"71351001012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prevail      Pad Large","code_information":[{"code":"CP17744631830820193","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891094951","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Systane Comp Sol 0.6%","code_information":[{"code":"CP17744631831097016","type":"CDM"},{"code":"250","type":"RC"},{"code":"65048","type":"CPT","modifier":"155"}],"standard_charges":[{"setting":"outpatient","modifier_code":["155"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831145459","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436016006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Zinc/vit A&d/lidocaine/emolle","code_information":[{"code":"CP17744631831403816","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162091838","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acetamin Er Tb 650mg","code_information":[{"code":"CP17744631828192529","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Acetaminophe Tab 650mg","code_information":[{"code":"CP17744631828206886","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Acetaminophen Er 650mg Tbcr","code_information":[{"code":"CP17744631828246666","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Acetaminophen Er-650mg-tbcr","code_information":[{"code":"CP17744631828246847","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Acyclovir    Tab 800mg","code_information":[{"code":"CP17744631828332138","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722077801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Alclometason Cre 0.05%","code_information":[{"code":"CP17744631828398061","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluorouracil Cre 5%","code_information":[{"code":"CP17744631829976713","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714017801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluorouricil:calcipotriene1:1","code_information":[{"code":"CP17744631829972608","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714017801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Klor-con/ef  Tab 25meq","code_information":[{"code":"CP17744631830194356","type":"CDM"},{"code":"250","type":"RC"},{"code":"24553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Klor-con/ef  Tab 25meq Fr","code_information":[{"code":"CP17744631830193640","type":"CDM"},{"code":"250","type":"RC"},{"code":"24553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Labetalol    Tab 200mg","code_information":[{"code":"CP17744631830203479","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687045001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830812299","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830812684","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228035390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin   Cap 100mg","code_information":[{"code":"CP17744631830812364","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762134801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830812577","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228035490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830812914","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762135101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830819911","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830813161","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238131409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 200mg","code_information":[{"code":"CP17744631830820128","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762135401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 200mg","code_information":[{"code":"CP17744631830829180","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 200mg","code_information":[{"code":"CP17744631830820051","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598029690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 200mg","code_information":[{"code":"CP17744631830828448","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228035590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 200mg","code_information":[{"code":"CP17744631830826456","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238131509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 200mg","code_information":[{"code":"CP17744631830825668","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 225mg","code_information":[{"code":"CP17744631830821960","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598029790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830826993","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228035090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830823296","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598029190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pregabalin   Cap 300mg","code_information":[{"code":"CP17744631830828629","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228035790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pregabalin   Cap 300mg","code_information":[{"code":"CP17744631830829677","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762136401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pregabalin   Cap 50mg","code_information":[{"code":"CP17744631830828394","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin   Cap 50mg","code_information":[{"code":"CP17744631830821982","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238131109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin   Cap 50mg","code_information":[{"code":"CP17744631830829030","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762134401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830829928","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762134601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830820439","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228035290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830828221","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238131209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Pregabalin-100mg-caps","code_information":[{"code":"CP17744631830821956","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Pregabalin-200mg-caps","code_information":[{"code":"CP17744631830822759","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598029690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin-200mg-caps","code_information":[{"code":"CP17744631830828068","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205001690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tretinoin    Cre 0.1%","code_information":[{"code":"CP17744631831171175","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714025002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Vilazodone   Tab 10mg","code_information":[{"code":"CP17744631831272208","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332023230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Vilazodone   Tab 20mg","code_information":[{"code":"CP17744631831274943","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332023330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Vilazodone   Tab 40mg","code_information":[{"code":"CP17744631831274268","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332023430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Vivarin      Tab 200mg","code_information":[{"code":"CP17744631831302473","type":"CDM"},{"code":"250","type":"RC"},{"code":"46017001816","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"60ml Syringe Mis Luer-loc","code_information":[{"code":"CP17744631828098213","type":"CDM"},{"code":"250","type":"RC"},{"code":"8881560125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ML"}},{"description":"Asa/dipyrida Cap 25-200mg","code_information":[{"code":"CP17744631828757614","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462040560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Asa/dipyrida Cap 25-200mg","code_information":[{"code":"CP17744631828750882","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162059606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Aspirin-dipyridamole 25/200mg","code_information":[{"code":"CP17744631828779452","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162059606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Atorvaliq    Sus 20mg/5ml","code_information":[{"code":"CP17744631828780485","type":"CDM"},{"code":"250","type":"RC"},{"code":"46287003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829011176","type":"CDM"},{"code":"250","type":"RC"},{"code":"52740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Butal-acet-caff 50-325-40 Cap","code_information":[{"code":"CP17744631829041645","type":"CDM"},{"code":"250","type":"RC"},{"code":"52740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Carb/levo100 Tab /Entacap","code_information":[{"code":"CP17744631829113682","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Cephalexin   Tab 250mg","code_information":[{"code":"CP17744631829190490","type":"CDM"},{"code":"250","type":"RC"},{"code":"93223","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cetirizine   Tab 10mg","code_information":[{"code":"CP17744631829207073","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660093901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cetirizine   Tab 5mg","code_information":[{"code":"CP17744631829203315","type":"CDM"},{"code":"250","type":"RC"},{"code":"78116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829262601","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829261252","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cromolyn Sod Neb 20mg/2ml","code_information":[{"code":"CP17744631829432107","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571035009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Cyclosporine Cap 100mg Md","code_information":[{"code":"CP17744631829448895","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155083930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Delivery Mile Fee","code_information":[{"code":"CP17744631829554437","type":"CDM"},{"code":"250","type":"RC"},{"code":"99993154660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diltiazem    Cap 60mg Er","code_information":[{"code":"CP17744631829698014","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462085001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Diphen/atrop Liq 2.5/5","code_information":[{"code":"CP17744631829700489","type":"CDM"},{"code":"250","type":"RC"},{"code":"54319","type":"CPT","modifier":"446"}],"standard_charges":[{"setting":"outpatient","modifier_code":["446"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Enema Ready- Ene -To-use","code_information":[{"code":"CP17744631829779410","type":"CDM"},{"code":"250","type":"RC"},{"code":"53674","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ezetimibe    Tab 10mg","code_information":[{"code":"CP17744631829837042","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714081301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829966480","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111014401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829962225","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710113801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluconazole 100mg Tabs","code_information":[{"code":"CP17744631829963646","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710113801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hearing Aid Battery 13","code_information":[{"code":"CP17744631830073555","type":"CDM"},{"code":"250","type":"RC"},{"code":"41333000277","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Imatinib Mes Tab 400mg","code_information":[{"code":"CP17744631830135957","type":"CDM"},{"code":"250","type":"RC"},{"code":"72819018603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830308819","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954085230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830304701","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954085210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Oxazepam     Cap 30mg","code_information":[{"code":"CP17744631830704632","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Primidone    Tab 125mg","code_information":[{"code":"CP17744631830830868","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817011710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Prochlorper  Inj 10mg/2ml","code_information":[{"code":"CP17744631830835766","type":"CDM"},{"code":"250","type":"RC"},{"code":"43066009025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Tramadol Hcl Tab 200mg Er","code_information":[{"code":"CP17744631831165463","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180069806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tretinoin    Cre 0.05%","code_information":[{"code":"CP17744631831175469","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672139400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Valsartan    Tab 320mg","code_information":[{"code":"CP17744631831222490","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162084009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Zinc Oint /Nystatin/clobet Oin","code_information":[{"code":"CP17744631831391444","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922001707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828518241","type":"CDM"},{"code":"250","type":"RC"},{"code":"78123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ampicillin/sulb 3 Gm/100 Ml Ns","code_information":[{"code":"CP17744631828520178","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ampicillin/sulba3gm/100ml Ns","code_information":[{"code":"CP17744631828522946","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"GR"}},{"description":"Ampicillin-sul 1.5gm/100ml Ns","code_information":[{"code":"CP17744631828527177","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Ampicillin-sulb 1.5gm /50ml Mb","code_information":[{"code":"CP17744631828531706","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Amp-sulb Inj 1.5g/ns  100ml","code_information":[{"code":"CP17744631828532361","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"GR"}},{"description":"Amp-sulbacta Inj 1-0.5gm","code_information":[{"code":"CP17744631828538048","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150011620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cetirizine   Tab 10mg","code_information":[{"code":"CP17744631829203385","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571040210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cetirizine   Tab 5mg","code_information":[{"code":"CP17744631829208654","type":"CDM"},{"code":"250","type":"RC"},{"code":"37836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cetirizine 10mg Tabs","code_information":[{"code":"CP17744631829202950","type":"CDM"},{"code":"250","type":"RC"},{"code":"37836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clindamycin 600mg/100 Ml Ns","code_information":[{"code":"CP17744631829253421","type":"CDM"},{"code":"250","type":"RC"},{"code":"90870","type":"CPT","modifier":"26"}],"standard_charges":[{"setting":"outpatient","modifier_code":["26"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Clindamycin 900mg/100 Ml Ns","code_information":[{"code":"CP17744631829253424","type":"CDM"},{"code":"250","type":"RC"},{"code":"90870","type":"CPT","modifier":"26"}],"standard_charges":[{"setting":"outpatient","modifier_code":["26"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":900,"type":"ME"}},{"description":"Clobetasol   Oin 0.05%","code_information":[{"code":"CP17744631829260305","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dipyridamole Tab 50mg","code_information":[{"code":"CP17744631829705321","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980013401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Foley Catheter 16fr 30cc","code_information":[{"code":"CP17744631829994755","type":"CDM"},{"code":"250","type":"RC"},{"code":"15350","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Megestrol    Sus 625mg/5m","code_information":[{"code":"CP17744631830414581","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979004113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Muro 128     Sol 5% Op","code_information":[{"code":"CP17744631830525696","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208027715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":128,"type":"EA"}},{"description":"Ribavirin    Tab 200mg","code_information":[{"code":"CP17744631830897224","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862020768","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cetirizine   Tab 10mg","code_information":[{"code":"CP17744631829202478","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714079902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clindamy/ben Gel 1-5%","code_information":[{"code":"CP17744631829259719","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672138104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diltiazem    Tab 120mg Er","code_information":[{"code":"CP17744631829696479","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682070430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Furosemide   Inj 20mg/2ml","code_information":[{"code":"CP17744631830001825","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603013325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Hydromorphon Tab 4mg","code_information":[{"code":"CP17744631830117745","type":"CDM"},{"code":"250","type":"RC"},{"code":"40632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Linezolid    Sus 100/5ml","code_information":[{"code":"CP17744631830347314","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722086525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Mercaptopur  Tab 50mg","code_information":[{"code":"CP17744631830424722","type":"CDM"},{"code":"250","type":"RC"},{"code":"69076091302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Mercaptopur  Tab 50mg","code_information":[{"code":"CP17744631830421061","type":"CDM"},{"code":"250","type":"RC"},{"code":"54458","type":"CPT","modifier":"111"}],"standard_charges":[{"setting":"outpatient","modifier_code":["111"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Prazosin Hcl Cap 1mg","code_information":[{"code":"CP17744631830810461","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954001920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ropinirole   Tab 6mg Er","code_information":[{"code":"CP17744631830915016","type":"CDM"},{"code":"250","type":"RC"},{"code":"22836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Ropinirole   Tab 8mg Er","code_information":[{"code":"CP17744631830914530","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111066230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ropinirole   Tab 8mg Er","code_information":[{"code":"CP17744631830914184","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111066290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Ropinirole   Tab 8mg Er","code_information":[{"code":"CP17744631830917489","type":"CDM"},{"code":"250","type":"RC"},{"code":"22836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Smz-tmp      Inj 400-80/5","code_information":[{"code":"CP17744631831033319","type":"CDM"},{"code":"250","type":"RC"},{"code":"70395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Betamethasone Dip 0.05% Crm","code_information":[{"code":"CP17744631828871407","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clindamycin  Cre 2% Vag","code_information":[{"code":"CP17744631829258550","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dexmethylphe Cap 5mg Er","code_information":[{"code":"CP17744631829578876","type":"CDM"},{"code":"250","type":"RC"},{"code":"52781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Divalproex   Tab 500mg Er","code_information":[{"code":"CP17744631829718495","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714048502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Divalproex Er 500mg Tabs","code_information":[{"code":"CP17744631829713708","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714048502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Dofetilide   Cap 125mcg","code_information":[{"code":"CP17744631829713747","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729049012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Dofetilide   Cap 250mcg","code_information":[{"code":"CP17744631829724909","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729049112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dofetilide   Cap 500mcg","code_information":[{"code":"CP17744631829726655","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729049212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830112857","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714011002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ivizia Dry   Sol 0.05%","code_information":[{"code":"CP17744631830170919","type":"CDM"},{"code":"250","type":"RC"},{"code":"94841085008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ivizia Dry   Sol 0.5%","code_information":[{"code":"CP17744631830175001","type":"CDM"},{"code":"250","type":"RC"},{"code":"94841085008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Ivizia Dry Eye","code_information":[{"code":"CP17744631830174532","type":"CDM"},{"code":"250","type":"RC"},{"code":"94841085008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketotif Fum  Dro 0.025%op","code_information":[{"code":"CP17744631830198636","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketotif Fum  Dro 0.035%op","code_information":[{"code":"CP17744631830191378","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine Sul Tab 30mg Er","code_information":[{"code":"CP17744631830504968","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Topiramate   Tab 200mg","code_information":[{"code":"CP17744631831153891","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382014114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Topiramate   Tab 200mg","code_information":[{"code":"CP17744631831154183","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335071213","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Topiramate   Tab 200mg","code_information":[{"code":"CP17744631831157510","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382014105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Topiramate   Tab 200mg","code_information":[{"code":"CP17744631831151545","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335071286","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Zyrtec-d     Tab 5-120mg","code_information":[{"code":"CP17744631831416942","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580071912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chlorhex Glu Cloths 2%","code_information":[{"code":"CP17744631829210699","type":"CDM"},{"code":"250","type":"RC"},{"code":"53329024401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Clindamycin  Gel 1%","code_information":[{"code":"CP17744631829254685","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922002705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Cap 25mg Mod","code_information":[{"code":"CP17744631829448237","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155083730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diclo/misopr Tab 50-0.2mg","code_information":[{"code":"CP17744631829594237","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162043606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dulcolax     Sup 10mg","code_information":[{"code":"CP17744631829751066","type":"CDM"},{"code":"250","type":"RC"},{"code":"81421002103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fexofenadine Tab 180mg","code_information":[{"code":"CP17744631829947032","type":"CDM"},{"code":"250","type":"RC"},{"code":"37807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Huber Needle Mis 22gx1.5\"","code_information":[{"code":"CP17744631830080856","type":"CDM"},{"code":"250","type":"RC"},{"code":"8287126906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroxychlor Tab 300mg","code_information":[{"code":"CP17744631830119766","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598013201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Iv Admin Set Dial A Flow","code_information":[{"code":"CP17744631830174495","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"950","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":1,"discounted_cash":1}]},{"description":"Nizatidine   Sol 15mg/ml","code_information":[{"code":"CP17744631830578270","type":"CDM"},{"code":"250","type":"RC"},{"code":"60846030115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Sevelam Hcl  Tab 800mg","code_information":[{"code":"CP17744631831002882","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelam Hcl  Tab 800mg","code_information":[{"code":"CP17744631831005621","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342024257","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelam Hcl  Tab 800mg","code_information":[{"code":"CP17744631831002624","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651008818","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831019449","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831013374","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651008818","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl 800mg (Renagel)","code_information":[{"code":"CP17744631831013880","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl 800mg Tab","code_information":[{"code":"CP17744631831013112","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl 800mg Tabs","code_information":[{"code":"CP17744631831015091","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hcl Tab 800mg","code_information":[{"code":"CP17744631831018490","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Hyd 800mg Tabs","code_information":[{"code":"CP17744631831012758","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462044718","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sod Chloride Inj 0.9%","code_information":[{"code":"CP17744631831047845","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Testosterone Gel 1.62%","code_information":[{"code":"CP17744631831110154","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603026501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831141497","type":"CDM"},{"code":"250","type":"RC"},{"code":"93716","type":"CPT","modifier":"356"}],"standard_charges":[{"setting":"outpatient","modifier_code":["356"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831140690","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975032203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831145819","type":"CDM"},{"code":"250","type":"RC"},{"code":"93716","type":"CPT","modifier":"398"}],"standard_charges":[{"setting":"outpatient","modifier_code":["398"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 2mg Er","code_information":[{"code":"CP17744631831147598","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975032209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831141250","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975032309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831149023","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975032303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831148001","type":"CDM"},{"code":"250","type":"RC"},{"code":"93716","type":"CPT","modifier":"498"}],"standard_charges":[{"setting":"outpatient","modifier_code":["498"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Cap 4mg Er","code_information":[{"code":"CP17744631831146818","type":"CDM"},{"code":"250","type":"RC"},{"code":"93716","type":"CPT","modifier":"456"}],"standard_charges":[{"setting":"outpatient","modifier_code":["456"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Topiramate   Tab 200mg","code_information":[{"code":"CP17744631831153630","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097012503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828517496","type":"CDM"},{"code":"250","type":"RC"},{"code":"40689","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Batteryaa","code_information":[{"code":"CP17744631828840539","type":"CDM"},{"code":"250","type":"RC"},{"code":"41333021501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromocriptin Tab 2.5mg","code_information":[{"code":"CP17744631828951256","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carbamazepin Tab 200mg Er","code_information":[{"code":"CP17744631829125856","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714006401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Carbamazepine Er 200mg Tabs","code_information":[{"code":"CP17744631829122887","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714006401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Catheter Self-adhering","code_information":[{"code":"CP17744631829144796","type":"CDM"},{"code":"250","type":"RC"},{"code":"8131718500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefuroxime   Tab 500mg","code_information":[{"code":"CP17744631829186520","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237005960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefuroxime   Tab 500mg","code_information":[{"code":"CP17744631829185365","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180030360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciclopirox 8% Sol","code_information":[{"code":"CP17744631829220543","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672530200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829234192","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Diltiazem    Cap 120mg Er","code_information":[{"code":"CP17744631829683572","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304071805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Dividers For Medcarts","code_information":[{"code":"CP17744631829719381","type":"CDM"},{"code":"250","type":"RC"},{"code":"11111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol    Cre 0.01%","code_information":[{"code":"CP17744631829810516","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781010444","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estradiol 0.1mg/gm Cream","code_information":[{"code":"CP17744631829825210","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781010444","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Foley Catheters Silicone","code_information":[{"code":"CP17744631829993663","type":"CDM"},{"code":"250","type":"RC"},{"code":"11502000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iodosorb     Gel 0.9%","code_information":[{"code":"CP17744631830156196","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565012256","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":9,"type":"EA"}},{"description":"Iv Catheter 20g 1 Inch Ns","code_information":[{"code":"CP17744631830178769","type":"CDM"},{"code":"250","type":"RC"},{"code":"85466500000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Muro 128     Sol 2% Op","code_information":[{"code":"CP17744631830529129","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208027615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":128,"type":"EA"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830668067","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071311","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxandrolone  Tab 2.5mg","code_information":[{"code":"CP17744631830707518","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884030101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Paricalcitol Cap 1 Mcg","code_information":[{"code":"CP17744631830737260","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483068703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Phenytoin    Sus 100/4ml","code_information":[{"code":"CP17744631830765899","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687027566","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Progesterone Inj 50mg/ml","code_information":[{"code":"CP17744631830838218","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323026110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ziprasidone  Cap 20mg","code_information":[{"code":"CP17744631831401400","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342014409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ziprasidone  Cap 40mg","code_information":[{"code":"CP17744631831407131","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342014509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Budesonide   Sus 32mcg","code_information":[{"code":"CP17744631828967529","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122038976","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Cloraz Dipot Tab 7.5mg","code_information":[{"code":"CP17744631829384692","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cloraz Dipot Tab 7.5mg","code_information":[{"code":"CP17744631829384967","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107032001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cloraz Dipot Tab 7.5mg","code_information":[{"code":"CP17744631829383043","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603011301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Etodolac Er  Tab 500mg","code_information":[{"code":"CP17744631829820835","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382027201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levoxyl      Tab 125mcg","code_information":[{"code":"CP17744631830325901","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793085601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Methazolamid Tab 50mg","code_information":[{"code":"CP17744631830446639","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603016701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Mycophenolat Tab 500mg","code_information":[{"code":"CP17744631830524829","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380072506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Mycophenolat Tab 500mg","code_information":[{"code":"CP17744631830525294","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877022501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Prednisone   Tab 50mg","code_information":[{"code":"CP17744631830815496","type":"CDM"},{"code":"250","type":"RC"},{"code":"54001","type":"CPT","modifier":"925"}],"standard_charges":[{"setting":"outpatient","modifier_code":["925"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830820711","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877046605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830822487","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877046290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pregabalin   Cap 75mg","code_information":[{"code":"CP17744631830826416","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877046490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Propafenone  Tab 300mg","code_information":[{"code":"CP17744631830849989","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651025801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Pyridostigmi Sol 60mg/5ml","code_information":[{"code":"CP17744631830859045","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954014810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Sinus Rinse  Pow Btle Kit","code_information":[{"code":"CP17744631831024765","type":"CDM"},{"code":"250","type":"RC"},{"code":"5928000308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tiagabine    Tab 4mg","code_information":[{"code":"CP17744631831128810","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205008530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-20mg","code_information":[{"code":"CP17744631828480357","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241008509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-20mg","code_information":[{"code":"CP17744631828487269","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-20mg","code_information":[{"code":"CP17744631828485235","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-20mg","code_information":[{"code":"CP17744631828489119","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462056690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-20mg","code_information":[{"code":"CP17744631828480433","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241008309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-20mg","code_information":[{"code":"CP17744631828481580","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-20mg","code_information":[{"code":"CP17744631828483756","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241008303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-20mg","code_information":[{"code":"CP17744631828480236","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571023530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/olmesa Tab 5-20mg","code_information":[{"code":"CP17744631828484602","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877049930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/valsar Tab 10-320mg","code_information":[{"code":"CP17744631828488145","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/valsar Tab 10-320mg","code_information":[{"code":"CP17744631828486782","type":"CDM"},{"code":"250","type":"RC"},{"code":"37817","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/valsar Tab 10-320mg","code_information":[{"code":"CP17744631828487087","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155084703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Armour Thyro Tab 60mg","code_information":[{"code":"CP17744631828756980","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Cefazolin    Inj 1gm","code_information":[{"code":"CP17744631829149543","type":"CDM"},{"code":"250","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefpodo Prox Sus 100/5ml","code_information":[{"code":"CP17744631829175702","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980040310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829401831","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010000201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Drospire/eth Tab Estr/lev","code_information":[{"code":"CP17744631829745710","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180089473","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Duloxetine   Cap 40mg","code_information":[{"code":"CP17744631829756743","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180029706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gentamicin   Oin 0.1%","code_information":[{"code":"CP17744631830020653","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802004635","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methylfol/me Cap Cbl/p5p","code_information":[{"code":"CP17744631830444690","type":"CDM"},{"code":"250","type":"RC"},{"code":"76439040390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Mycophenolat Tab 500mg","code_information":[{"code":"CP17744631830524784","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729001916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Mycophenolat Tab 500mg","code_information":[{"code":"CP17744631830528216","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729001901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Mycophenolate 500mg Tabs","code_information":[{"code":"CP17744631830521204","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729001916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830675058","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884078609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olmsrtn-amldpn-hctz 20-5-12.5","code_information":[{"code":"CP17744631830676127","type":"CDM"},{"code":"250","type":"RC"},{"code":"93500","type":"CPT","modifier":"556"}],"standard_charges":[{"setting":"outpatient","modifier_code":["556"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paroxetine   Tab 10mg","code_information":[{"code":"CP17744631830730716","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382009705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Propafenone  Cap 225mg Er","code_information":[{"code":"CP17744631830844974","type":"CDM"},{"code":"250","type":"RC"},{"code":"83207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Propafenone  Cap 225mg Er","code_information":[{"code":"CP17744631830846329","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714082501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Systane Bal  Sol Restor","code_information":[{"code":"CP17744631831092217","type":"CDM"},{"code":"250","type":"RC"},{"code":"65143","type":"CPT","modifier":"302"}],"standard_charges":[{"setting":"outpatient","modifier_code":["302"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tetracycline Cap 250mg","code_information":[{"code":"CP17744631831126835","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155076601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Tetracycline Cap 250mg","code_information":[{"code":"CP17744631831126056","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155001701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Urea         Cre 40%","code_information":[{"code":"CP17744631831212088","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291084928","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Amlodipine / Ator 2.5-10mg Tab","code_information":[{"code":"CP17744631828493785","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762671001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Azithromycin 250mg Tabs","code_information":[{"code":"CP17744631828807356","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin 250mg Tabs","code_information":[{"code":"CP17744631828805359","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180016013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828817109","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828817695","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762219803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828816333","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828812962","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679096101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828812064","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679096105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828812926","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224002230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828814793","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862064130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828813484","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111078766","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828819234","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862064163","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828811934","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224002206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828819037","type":"CDM"},{"code":"250","type":"RC"},{"code":"52723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Azithromycin Tab 250mg","code_information":[{"code":"CP17744631828819932","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224002218","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clobazam     Sus 2.5mg/ml","code_information":[{"code":"CP17744631829250171","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714008701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829409472","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598037201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Cyclobenzapr Tab 10mg","code_information":[{"code":"CP17744631829435485","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dexmethylphe Cap 5mg Er","code_information":[{"code":"CP17744631829579275","type":"CDM"},{"code":"250","type":"RC"},{"code":"11599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Digoxin      Sol 50mcg/ml","code_information":[{"code":"CP17744631829608435","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689032702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Donepezil    Tab 5mg Odt","code_information":[{"code":"CP17744631829727716","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342002907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Donepezil    Tab Odt 5mg","code_information":[{"code":"CP17744631829728529","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300025087","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fenofibrate  Cap 130mg","code_information":[{"code":"CP17744631829853668","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505312109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":130,"type":"ME"}},{"description":"Foley Catheter 20f/5cc","code_information":[{"code":"CP17744631829991365","type":"CDM"},{"code":"250","type":"RC"},{"code":"11111004338","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroco/apap Tab 5-325mg","code_information":[{"code":"CP17744631830101387","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hydroxyz Hcl Syp 10mg/5ml","code_information":[{"code":"CP17744631830110383","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135050247","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hydroxyz Hcl Syp 10mg/5ml","code_information":[{"code":"CP17744631830113907","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135075047","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Lansoprazole Sus 3mg/ml","code_information":[{"code":"CP17744631830217138","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628008005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Latanoprost  Sol 0.005%","code_information":[{"code":"CP17744631830224099","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478062512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Pad 4%","code_information":[{"code":"CP17744631830333435","type":"CDM"},{"code":"250","type":"RC"},{"code":"12109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Octreotide   Inj 100mcg","code_information":[{"code":"CP17744631830652145","type":"CDM"},{"code":"250","type":"RC"},{"code":"70333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Pot Citra Er Tab 1620mg","code_information":[{"code":"CP17744631830790159","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559029201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1620,"type":"ME"}},{"description":"Theophylline Tab 450mg Er","code_information":[{"code":"CP17744631831120470","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155074201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":450,"type":"ME"}},{"description":"Alpha Lipoic Cap 300mg","code_information":[{"code":"CP17744631828439195","type":"CDM"},{"code":"250","type":"RC"},{"code":"47469000312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828518593","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amphet/dextr Cap 25mg Er","code_information":[{"code":"CP17744631828511684","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Aspirin      Sup 300mg","code_information":[{"code":"CP17744631828760830","type":"CDM"},{"code":"250","type":"RC"},{"code":"57470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Banatrol     Pak Plus","code_information":[{"code":"CP17744631828834351","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688018470","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Buprenorphin Sub 8mg","code_information":[{"code":"CP17744631828980406","type":"CDM"},{"code":"250","type":"RC"},{"code":"54017","type":"CPT","modifier":"713"}],"standard_charges":[{"setting":"outpatient","modifier_code":["713"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Clonazep Odt Tab 1mg","code_information":[{"code":"CP17744631829374840","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664078686","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Contour      Tes Next","code_information":[{"code":"CP17744631829418204","type":"CDM"},{"code":"250","type":"RC"},{"code":"19373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dabigatran   Cap 75mg","code_information":[{"code":"CP17744631829464224","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722062160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Desoximetas  Cre 0.05%","code_information":[{"code":"CP17744631829564624","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180094902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Isosorb Mono Tab 60mg Er","code_information":[{"code":"CP17744631830165316","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668010510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Lidocain/zinc Oxide/ketoconazo","code_information":[{"code":"CP17744631830325431","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain/zinc Oxide/miconazole","code_information":[{"code":"CP17744631830323485","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Gel 2% Jelly","code_information":[{"code":"CP17744631830338290","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Methylphenid Tab 20mg Er","code_information":[{"code":"CP17744631830459170","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702007601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Methylphenid Tab 20mg Er","code_information":[{"code":"CP17744631830451594","type":"CDM"},{"code":"250","type":"RC"},{"code":"40614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Poly Glycol 3350 Pack","code_information":[{"code":"CP17744631830785555","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079030630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3350,"type":"EA"}},{"description":"Polyeth Glyc Pow 3350 Nf","code_information":[{"code":"CP17744631830784433","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079030630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tobramycin   Sol 0.3% Op","code_information":[{"code":"CP17744631831141857","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478029010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Baclofen     Tab 15mg","code_information":[{"code":"CP17744631828828901","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710166601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Carbamazepin Chw 200mg","code_information":[{"code":"CP17744631829111319","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672405001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829212097","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462086201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829219688","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304014301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829217122","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710113001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829212708","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332073631","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829216649","type":"CDM"},{"code":"250","type":"RC"},{"code":"52729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829210654","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238105601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829213480","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155080401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829265265","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383026760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829263014","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700010917","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829261588","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565005160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829268981","type":"CDM"},{"code":"250","type":"RC"},{"code":"16801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829266515","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291007660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Sha 0.05%","code_information":[{"code":"CP17744631829364357","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383097904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol 0.05% Cream","code_information":[{"code":"CP17744631829365924","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565005160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol 0.05% Cream","code_information":[{"code":"CP17744631829360720","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672125803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cromolyn Sod Con 100/5ml","code_information":[{"code":"CP17744631829433979","type":"CDM"},{"code":"250","type":"RC"},{"code":"51525047009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Culturelle   Cap","code_information":[{"code":"CP17744631829433321","type":"CDM"},{"code":"250","type":"RC"},{"code":"49100040007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Danazol      Cap 100mg","code_information":[{"code":"CP17744631829478301","type":"CDM"},{"code":"250","type":"RC"},{"code":"55506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dapsone      Tab 100mg","code_information":[{"code":"CP17744631829479371","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954013620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Eye Itch Rel Dro 0.025%op","code_information":[{"code":"CP17744631829838937","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348010717","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluoxetine   Cap 10mg","code_information":[{"code":"CP17744631829972067","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019299","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluoxetine 10mg Caps","code_information":[{"code":"CP17744631829971021","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019299","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluoxetine Hcl Cap 10mg","code_information":[{"code":"CP17744631829973935","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019299","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Glipizide    Tab 2.5mg","code_information":[{"code":"CP17744631830048779","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817038510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hyoscyamine  Dro 0.125/ml","code_information":[{"code":"CP17744631830123878","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328004715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido/silv/pet","code_information":[{"code":"CP17744631830329005","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Cre 3%","code_information":[{"code":"CP17744631830327944","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925015901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830330376","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine/nystatin/zinc Oint","code_information":[{"code":"CP17744631830345833","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Neo/poly/dex Sus 0.1% Op","code_information":[{"code":"CP17744631830549500","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pyridostigm  Tab 60mg","code_information":[{"code":"CP17744631830859613","type":"CDM"},{"code":"250","type":"RC"},{"code":"11535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Pyridostigmine 60mg Tabs","code_information":[{"code":"CP17744631830858714","type":"CDM"},{"code":"250","type":"RC"},{"code":"11535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Stomahesive  Mis Moldable","code_information":[{"code":"CP17744631831078734","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455010702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Stretch Bandage 4in","code_information":[{"code":"CP17744631831076016","type":"CDM"},{"code":"250","type":"RC"},{"code":"41405061200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tegaderm Film 4x4","code_information":[{"code":"CP17744631831107209","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333162601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Tegaderm Flm Mis 4\"x4-3/4","code_information":[{"code":"CP17744631831104246","type":"CDM"},{"code":"250","type":"RC"},{"code":"8333162601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tizanidine   Tab 4mg","code_information":[{"code":"CP17744631831137543","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505025202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Topiramate   Tab 200mg","code_information":[{"code":"CP17744631831155078","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097012512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Trihexyphen  Tab 2mg","code_information":[{"code":"CP17744631831194398","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452024120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Zinc /Vit A&d/lidocaine/emolle","code_information":[{"code":"CP17744631831397377","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc/a&d Oin/hydrop/lidoc Oin","code_information":[{"code":"CP17744631831401973","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc/vit A&d/lidocaine/emolle","code_information":[{"code":"CP17744631831405211","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zn/ad/li/cet Butt Cream","code_information":[{"code":"CP17744631831401994","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Arzol Silver Mis Nitr App","code_information":[{"code":"CP17744631828755722","type":"CDM"},{"code":"250","type":"RC"},{"code":"12870000101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Astepro      Spr 205.5mcg","code_information":[{"code":"CP17744631828771549","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100058992","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2055,"type":"ME"}},{"description":"Astepro Chld Spr 205.5mcg","code_information":[{"code":"CP17744631828779425","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100058993","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2055,"type":"ME"}},{"description":"Brimonidine  Sol 0.2% Op","code_information":[{"code":"CP17744631828953706","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Cefazolin    Inj 500mg","code_information":[{"code":"CP17744631829141509","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021010010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829186663","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668044201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829186116","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862090901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829187334","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241002405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829186980","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505384901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829180095","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762151703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829185480","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571014405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829181946","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829181812","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806072201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829186239","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241002410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829185157","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834023801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Chlordiazep  Cap 25mg","code_information":[{"code":"CP17744631829219096","type":"CDM"},{"code":"250","type":"RC"},{"code":"55501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829264069","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714099204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desmopressin Tab 0.2mg","code_information":[{"code":"CP17744631829564097","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155049001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Desmopressin Tab 0.2mg","code_information":[{"code":"CP17744631829561897","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918020101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Desmopressin Tab 0.2mg","code_information":[{"code":"CP17744631829565279","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702017001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Disulfiram   Tab 250mg","code_information":[{"code":"CP17744631829717924","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781060730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Hydrophil Catheter 16\"l","code_information":[{"code":"CP17744631830114327","type":"CDM"},{"code":"250","type":"RC"},{"code":"51083700000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lactaid      Tab 3000unit","code_information":[{"code":"CP17744631830203906","type":"CDM"},{"code":"250","type":"RC"},{"code":"90452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3000,"type":"UN"}},{"description":"Lactase Enz  Tab 3000unit","code_information":[{"code":"CP17744631830209317","type":"CDM"},{"code":"250","type":"RC"},{"code":"90452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3000,"type":"UN"}},{"description":"Lactase Enzyme 3000unit Tabs","code_information":[{"code":"CP17744631830201573","type":"CDM"},{"code":"250","type":"RC"},{"code":"90452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3000,"type":"UN"}},{"description":"Lidcin/diclfnc/mylnta/caldesen","code_information":[{"code":"CP17744631830325185","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidcin/diclfnc/mylnta/nystatin","code_information":[{"code":"CP17744631830325319","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido 5%diclo 1%calmyl","code_information":[{"code":"CP17744631830325294","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lido5%/zin20%/bacit/nystat Oin","code_information":[{"code":"CP17744631830327964","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lido5/asa/mylanta/triam0.1","code_information":[{"code":"CP17744631830322370","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830330079","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672300805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830332749","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830339593","type":"CDM"},{"code":"250","type":"RC"},{"code":"70752011304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830332997","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162091853","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830335777","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877047380","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830330834","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380078933","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830338354","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462041827","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Lidocaine    Oin 5%","code_information":[{"code":"CP17744631830331259","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714087802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Metolazone   Tab 5mg","code_information":[{"code":"CP17744631830459482","type":"CDM"},{"code":"250","type":"RC"},{"code":"52722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Minocycline  Tab 100mg","code_information":[{"code":"CP17744631830487367","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111063960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nicotine Td  Dis 14mg/24h","code_information":[{"code":"CP17744631830562112","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505708900","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830814924","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980041410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830826246","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335068688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Prochlorper  Inj 10mg/2ml","code_information":[{"code":"CP17744631830839955","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860077802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Sm Micon 7   Sup 100mg","code_information":[{"code":"CP17744631831032715","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348083361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ssd/lidocaine5%/vaseline","code_information":[{"code":"CP17744631831061777","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Systane Ulta Sol Pf","code_information":[{"code":"CP17744631831097876","type":"CDM"},{"code":"250","type":"RC"},{"code":"65150","type":"CPT","modifier":"782"}],"standard_charges":[{"setting":"outpatient","modifier_code":["782"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc /Vit A&d/lidocaine/emolle","code_information":[{"code":"CP17744631831398603","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc Oxide/a+d/lido Oin/cetaph","code_information":[{"code":"CP17744631831407622","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zinc/vit A&d/lidocaine/emolle","code_information":[{"code":"CP17744631831400761","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zn/ad/li/cet Butt Cream","code_information":[{"code":"CP17744631831407062","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zn/ad/li/cet Butt Cream2-2-1-1","code_information":[{"code":"CP17744631831407265","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672302002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Atovaquone   Sus 750/5ml","code_information":[{"code":"CP17744631828796842","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722062921","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Celecoxib    Cap 200mg","code_information":[{"code":"CP17744631829187123","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Celecoxib 200mg Caps","code_information":[{"code":"CP17744631829191946","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714073301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ciclopirox   Sus 0.77%","code_information":[{"code":"CP17744631829220700","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802040046","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Dabigatran   Cap 150mg","code_information":[{"code":"CP17744631829452316","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722062260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Diflucan     Tab 100mg","code_information":[{"code":"CP17744631829609546","type":"CDM"},{"code":"250","type":"RC"},{"code":"49342","type":"CPT","modifier":"30"}],"standard_charges":[{"setting":"outpatient","modifier_code":["30"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Diltiazem Er Tab 180mg","code_information":[{"code":"CP17744631829700127","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436019604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Eye Itch Rel Dro 0.025%op","code_information":[{"code":"CP17744631829839626","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000052201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Pad 4%","code_information":[{"code":"CP17744631830333988","type":"CDM"},{"code":"250","type":"RC"},{"code":"62379020103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metoprl/hctz Tab 100-25mg","code_information":[{"code":"CP17744631830464741","type":"CDM"},{"code":"250","type":"RC"},{"code":"37804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mucus Relief Er 600mg Tab","code_information":[{"code":"CP17744631830519347","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677004901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxycodone    Con 100/5ml","code_information":[{"code":"CP17744631830710958","type":"CDM"},{"code":"250","type":"RC"},{"code":"71930002330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Ropinirole   Tab 1mg","code_information":[{"code":"CP17744631830914759","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462025501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ropinirole Hcl Tab 1mg","code_information":[{"code":"CP17744631830910226","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462025501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sm Mucus Rel Tab 600mg Er","code_information":[{"code":"CP17744631831031501","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677004901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Tretinoin    Cre 0.1%","code_information":[{"code":"CP17744631831172026","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672139509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831251296","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033004530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831252672","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799096202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831254502","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831254174","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834021890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831250194","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722012530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831253887","type":"CDM"},{"code":"250","type":"RC"},{"code":"52726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831255088","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980058003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831251524","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877072830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831258556","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831259524","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710135003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831255069","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710135009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"1ml Tb Syrng Mis 25gx1\"","code_information":[{"code":"CP17744631828074419","type":"CDM"},{"code":"250","type":"RC"},{"code":"13703010161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Acidophilus Probiotic Caps","code_information":[{"code":"CP17744631828316969","type":"CDM"},{"code":"250","type":"RC"},{"code":"71351001760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amiodarone   Tab 400mg","code_information":[{"code":"CP17744631828478615","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494030903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Amiodarone   Tab 400mg","code_information":[{"code":"CP17744631828475385","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382029806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Amiodarone 400mg Tabs","code_information":[{"code":"CP17744631828474131","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494030903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Ampicillin   Inj 500mg","code_information":[{"code":"CP17744631828526216","type":"CDM"},{"code":"250","type":"RC"},{"code":"40937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Antacid      Chw 500mg","code_information":[{"code":"CP17744631828532593","type":"CDM"},{"code":"250","type":"RC"},{"code":"24385047847","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Azelaic Acid Gel 15%","code_information":[{"code":"CP17744631828808171","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922003814","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Azelaic Acid Gel 15%","code_information":[{"code":"CP17744631828808756","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462062652","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Bisacodyl    Sup 10mg","code_information":[{"code":"CP17744631828922940","type":"CDM"},{"code":"250","type":"RC"},{"code":"57470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829214543","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714004801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Compound W   Gel 17%","code_information":[{"code":"CP17744631829417900","type":"CDM"},{"code":"250","type":"RC"},{"code":"75137058507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":17,"type":"EA"}},{"description":"Diltiazem    Cap 120mg Er","code_information":[{"code":"CP17744631829602090","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979018301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Fluocinonide Cre 0.05%","code_information":[{"code":"CP17744631829976789","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"High Potency Cap Probioti","code_information":[{"code":"CP17744631830083180","type":"CDM"},{"code":"250","type":"RC"},{"code":"71351001760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Pad 4%","code_information":[{"code":"CP17744631830339334","type":"CDM"},{"code":"250","type":"RC"},{"code":"62379020102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metoprl/hctz Tab 100-25mg","code_information":[{"code":"CP17744631830464111","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332011631","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nasacort Alr Spr 55mcg/ac","code_information":[{"code":"CP17744631830543870","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167580005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":55,"type":"ME"}},{"description":"Niacin Er    Tab 1000mg","code_information":[{"code":"CP17744631830551155","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651002090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830642080","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462031417","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Oin","code_information":[{"code":"CP17744631830643718","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462079917","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831094499","type":"CDM"},{"code":"250","type":"RC"},{"code":"37820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Amiodarone   Tab 100mg","code_information":[{"code":"CP17744631828469803","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888006030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amiodarone   Tab 100mg","code_information":[{"code":"CP17744631828468739","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382029706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amiodarone   Tab 100mg","code_information":[{"code":"CP17744631828469459","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amiodarone 100mg Tabs","code_information":[{"code":"CP17744631828471703","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Bisoprl/hctz Tab 10/6.25","code_information":[{"code":"CP17744631828930351","type":"CDM"},{"code":"250","type":"RC"},{"code":"93324","type":"CPT","modifier":"356"}],"standard_charges":[{"setting":"outpatient","modifier_code":["356"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Bisoprl/hctz Tab 10/6.25","code_information":[{"code":"CP17744631828939338","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799092202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Bisoprl/hctz Tab 10/6.25","code_information":[{"code":"CP17744631828931215","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462088005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Bisoprl/hctz Tab 10/6.25","code_information":[{"code":"CP17744631828930763","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799092201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Bisoprl/hctz Tab 2.5/6.25","code_information":[{"code":"CP17744631828930366","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462087830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Bisoprl/hctz Tab 5-6.25mg","code_information":[{"code":"CP17744631828938045","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462087930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bisoprl/hctz Tab 5-6.25mg","code_information":[{"code":"CP17744631828932067","type":"CDM"},{"code":"250","type":"RC"},{"code":"93324","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bisoprl/hctz Tab 5-6.25mg","code_information":[{"code":"CP17744631828932948","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462087905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bisoprl/hctz Tab 5-6.25mg","code_information":[{"code":"CP17744631828934764","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799092102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bisoprolol Fum/hydro 10/6.25mg","code_information":[{"code":"CP17744631828935007","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799092201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Calc Acetate Tab 667mg","code_information":[{"code":"CP17744631829069776","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":667,"type":"ME"}},{"description":"Carb/levo150 Tab /Entacap","code_information":[{"code":"CP17744631829117573","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571069301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Drain Pouch  Mis Clamp","code_information":[{"code":"CP17744631829743315","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380008770","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ezetimibe/rosuvasta 10-10 Tabs","code_information":[{"code":"CP17744631829839375","type":"CDM"},{"code":"250","type":"RC"},{"code":"82120012630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Hc Valerate  Oin 0.2%","code_information":[{"code":"CP17744631830077841","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Hydrocolloid Dressing 4x4","code_information":[{"code":"CP17744631830107369","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Irbesartan   Tab 300mg","code_information":[{"code":"CP17744631830162688","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722073190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"K-phos       Tab No 2","code_information":[{"code":"CP17744631830198992","type":"CDM"},{"code":"250","type":"RC"},{"code":"48611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Nabumetone   Tab 500mg","code_information":[{"code":"CP17744631830533057","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228046501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ondansetron  Inj 4mg/2ml","code_information":[{"code":"CP17744631830688058","type":"CDM"},{"code":"250","type":"RC"},{"code":"76045010320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Systane Comp Sol 0.6%","code_information":[{"code":"CP17744631831091574","type":"CDM"},{"code":"250","type":"RC"},{"code":"65048","type":"CPT","modifier":"110"}],"standard_charges":[{"setting":"outpatient","modifier_code":["110"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Acetazolamid Cap 500mg Er","code_information":[{"code":"CP17744631828253820","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367020901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetic Acid  Sol 2% Otic","code_information":[{"code":"CP17744631828260287","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817081615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Azelaic Acid Gel 15%","code_information":[{"code":"CP17744631828808971","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Calcipotrien Cre 0.005%","code_information":[{"code":"CP17744631829065643","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Chloraprep Swabstick","code_information":[{"code":"CP17744631829210328","type":"CDM"},{"code":"250","type":"RC"},{"code":"52668","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desmopressin Tab 0.1mg","code_information":[{"code":"CP17744631829561663","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462027501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Diflunisal   Tab 500mg","code_information":[{"code":"CP17744631829600476","type":"CDM"},{"code":"250","type":"RC"},{"code":"14539067301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Hc Valerate  Oin 0.2%","code_information":[{"code":"CP17744631830078624","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462083617","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lasix        Tab 40mg","code_information":[{"code":"CP17744631830220508","type":"CDM"},{"code":"250","type":"RC"},{"code":"30698006001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Progesterone Inj 50mg/ml","code_information":[{"code":"CP17744631830837781","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150030610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Quinine Sulf Cap 324mg","code_information":[{"code":"CP17744631830875989","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742023830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":324,"type":"ME"}},{"description":"Refresh      Gel Optive","code_information":[{"code":"CP17744631830887576","type":"CDM"},{"code":"250","type":"RC"},{"code":"23545","type":"CPT","modifier":"910"}],"standard_charges":[{"setting":"outpatient","modifier_code":["910"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sulfamylon   Cre 85mg/gm","code_information":[{"code":"CP17744631831077631","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571072348","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":85,"type":"ME"}},{"description":"Systane      Gel 0.3%","code_information":[{"code":"CP17744631831094539","type":"CDM"},{"code":"250","type":"RC"},{"code":"65047","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Systane Nightgel","code_information":[{"code":"CP17744631831095119","type":"CDM"},{"code":"250","type":"RC"},{"code":"65047","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Testosterone Gel 1%(25mg)","code_information":[{"code":"CP17744631831118080","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884041872","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ursodiol     Cap 300mg","code_information":[{"code":"CP17744631831214167","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380084406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ursodiol     Cap 300mg","code_information":[{"code":"CP17744631831215416","type":"CDM"},{"code":"250","type":"RC"},{"code":"24658078001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ursodiol     Cap 300mg","code_information":[{"code":"CP17744631831213381","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651042101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ursodiol     Cap 300mg","code_information":[{"code":"CP17744631831212305","type":"CDM"},{"code":"250","type":"RC"},{"code":"59131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ursodiol     Cap 300mg","code_information":[{"code":"CP17744631831212124","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710148301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Vitamin B-12 Lzg 5000mcg","code_information":[{"code":"CP17744631831280366","type":"CDM"},{"code":"250","type":"RC"},{"code":"30768071958","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Armodafinil  Tab 50mg","code_information":[{"code":"CP17744631828757500","type":"CDM"},{"code":"250","type":"RC"},{"code":"93309","type":"CPT","modifier":"56"}],"standard_charges":[{"setting":"outpatient","modifier_code":["56"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Armodafinil  Tab 50mg","code_information":[{"code":"CP17744631828751409","type":"CDM"},{"code":"250","type":"RC"},{"code":"37834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Catheter     Mis 32mm","code_information":[{"code":"CP17744631829140974","type":"CDM"},{"code":"250","type":"RC"},{"code":"8380097532","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829408475","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714003902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Dentemp Loose Cap & Lost","code_information":[{"code":"CP17744631829556634","type":"CDM"},{"code":"250","type":"RC"},{"code":"55354970000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Doxepin Hcl  Cap 100mg","code_information":[{"code":"CP17744631829731607","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332064031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Econazole    Cre 1%","code_information":[{"code":"CP17744631829762094","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Endocet      Tab 7.5-325","code_information":[{"code":"CP17744631829779465","type":"CDM"},{"code":"250","type":"RC"},{"code":"60951070070","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Estradiol    Cre 0.01%","code_information":[{"code":"CP17744631829812677","type":"CDM"},{"code":"250","type":"RC"},{"code":"37887","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gemfibrozil  Tab 600mg","code_information":[{"code":"CP17744631830022647","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603020601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Lorazepam    Inj 2mg/ml","code_information":[{"code":"CP17744631830369148","type":"CDM"},{"code":"250","type":"RC"},{"code":"76329826101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Megestrol Ac Tab 20mg","code_information":[{"code":"CP17744631830410890","type":"CDM"},{"code":"250","type":"RC"},{"code":"55506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Mirtazapine  Tab 30mg Odt","code_information":[{"code":"CP17744631830491801","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Mirtazapine Odt 30mg Tabs","code_information":[{"code":"CP17744631830498130","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Con 100/5ml","code_information":[{"code":"CP17744631830719862","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830819049","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097068205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 300mg","code_information":[{"code":"CP17744631830821897","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097096205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Refresh Reli Dro 0.5-0.9%","code_information":[{"code":"CP17744631830881890","type":"CDM"},{"code":"250","type":"RC"},{"code":"23663","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828517864","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828519208","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amphet/dextr Cap 25mg Er","code_information":[{"code":"CP17744631828515781","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010003301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amphet/dextr Cap 5mg Er","code_information":[{"code":"CP17744631828516893","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010002901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aspartame    Pow","code_information":[{"code":"CP17744631828762547","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779309801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Banatrol     Pak Plus","code_information":[{"code":"CP17744631828833742","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688008470","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Banatrol Plus Powder Pack","code_information":[{"code":"CP17744631828836928","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688008470","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dextroamphet Cap 10mg Er","code_information":[{"code":"CP17744631829574523","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963030409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Eplerenone   Tab 25mg","code_information":[{"code":"CP17744631829794429","type":"CDM"},{"code":"250","type":"RC"},{"code":"18553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Foltanx      Tab","code_information":[{"code":"CP17744631829999787","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991081390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Sod  Inj 1000/ml","code_information":[{"code":"CP17744631830076885","type":"CDM"},{"code":"250","type":"RC"},{"code":"40927","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Loratadine   Chw 5mg","code_information":[{"code":"CP17744631830367016","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660011231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mercaptopur  Tab 50mg","code_information":[{"code":"CP17744631830427458","type":"CDM"},{"code":"250","type":"RC"},{"code":"37835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Metformin    Tab 750mg Er","code_information":[{"code":"CP17744631830432891","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877041401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Metformin    Tab 850mg","code_information":[{"code":"CP17744631830437807","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010006499","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Metronidazol Gel 1%","code_information":[{"code":"CP17744631830476790","type":"CDM"},{"code":"250","type":"RC"},{"code":"71305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mycophenolat Sus 200mg/ml","code_information":[{"code":"CP17744631830529908","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651064626","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Nicotine 14mg/24hr Patch","code_information":[{"code":"CP17744631830559306","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598044774","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Nicotine Td  Dis 14mg/24h","code_information":[{"code":"CP17744631830555655","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598044774","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":14,"type":"ME"}},{"description":"Nicotine Td  Dis 21mg/24h","code_information":[{"code":"CP17744631830569405","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598044874","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":21,"type":"ME"}},{"description":"Pain Relief  Pad 4%","code_information":[{"code":"CP17744631830721106","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677118801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pregabalin   Cap 25mg","code_information":[{"code":"CP17744631830827747","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097067705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Trifluoperaz Tab 2mg","code_information":[{"code":"CP17744631831185525","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Urea         Cre 40%","code_information":[{"code":"CP17744631831217045","type":"CDM"},{"code":"250","type":"RC"},{"code":"16477034001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Valacyclovir 500mg Tabs","code_information":[{"code":"CP17744631831218936","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valacyclovir Tab 500mg","code_information":[{"code":"CP17744631831214743","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valacyclovir Tab 500mg","code_information":[{"code":"CP17744631831228511","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237004290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valacyclovir Tab 500mg","code_information":[{"code":"CP17744631831223801","type":"CDM"},{"code":"250","type":"RC"},{"code":"78152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valacyclovir Tab 500mg","code_information":[{"code":"CP17744631831225732","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722070430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetic Acid  Sol 2% Otic","code_information":[{"code":"CP17744631828260594","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383088915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Apap/codeine Tab 300-30mg","code_information":[{"code":"CP17744631828722245","type":"CDM"},{"code":"250","type":"RC"},{"code":"40604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Atovaq/progu Tab 250-100","code_information":[{"code":"CP17744631828794807","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462040401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Baclofen     Tab 5mg","code_information":[{"code":"CP17744631828832687","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756008511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Benadryl/lido/nyst/dexa","code_information":[{"code":"CP17744631828857291","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betameth Val Cre 0.1%","code_information":[{"code":"CP17744631828876191","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupren/nalox Sub 2-0.5mg","code_information":[{"code":"CP17744631828976677","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162041603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Dexmethylph  Cap 30mg Er","code_information":[{"code":"CP17744631829575422","type":"CDM"},{"code":"250","type":"RC"},{"code":"52781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Diphen/geri/nyssus/lido","code_information":[{"code":"CP17744631829708611","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diphen/nystatin/maalo/lidoc","code_information":[{"code":"CP17744631829706980","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diphenhydramine/nys/gerilanta","code_information":[{"code":"CP17744631829705685","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Erythrom Eth Sus 400/5ml","code_information":[{"code":"CP17744631829803845","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219150402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Erythrom Eth Sus 400/5ml","code_information":[{"code":"CP17744631829802234","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834029401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fluorouracil Cre 5%","code_information":[{"code":"CP17744631829970914","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729054235","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829990201","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858009435","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Hc Butyrate  Sol 0.1%","code_information":[{"code":"CP17744631830072172","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672406104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lactobacillu Pak","code_information":[{"code":"CP17744631830205313","type":"CDM"},{"code":"250","type":"RC"},{"code":"71351001312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamivudine   Tab 150mg","code_information":[{"code":"CP17744631830213681","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862002560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamivudine   Tab 150mg","code_information":[{"code":"CP17744631830211964","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505325106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamivudine   Tab 150mg","code_information":[{"code":"CP17744631830215558","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342000109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamivudine 150mg Tabs","code_information":[{"code":"CP17744631830213809","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722075360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lido/mylan/diph/nyst/pred","code_information":[{"code":"CP17744631830323694","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain/diphen/nystat Sus","code_information":[{"code":"CP17744631830322081","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain/mylanta/diphen/nystat","code_information":[{"code":"CP17744631830325172","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lovastatin   Tab 20mg","code_information":[{"code":"CP17744631830376415","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180046801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Magnesium Diphenhyd Nystatin","code_information":[{"code":"CP17744631830393277","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mary's Magic Mouthwash 1","code_information":[{"code":"CP17744631830408085","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methimazole  Tab 10mg","code_information":[{"code":"CP17744631830449892","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629925101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mw Nystatin/dexa","code_information":[{"code":"CP17744631830520633","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mw Nystatin/lidocaine Vis 2%","code_information":[{"code":"CP17744631830520862","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Myla/diphen/nyst/pred/dist H2o","code_information":[{"code":"CP17744631830525065","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mylanta/diphen/nystat","code_information":[{"code":"CP17744631830525363","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mylanta/nystatin/diphen/predni","code_information":[{"code":"CP17744631830522433","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nyst/anta/diph 1:1:1","code_information":[{"code":"CP17744631830645447","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nyst/maa/bena/lid 1:1:1:1","code_information":[{"code":"CP17744631830645920","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin     Sus 100000","code_information":[{"code":"CP17744631830655397","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Nystatin,geri Lanta, Lv 2%","code_information":[{"code":"CP17744631830653238","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/alamag/siladryl","code_information":[{"code":"CP17744631830653565","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/bena/lid2%/dexameth","code_information":[{"code":"CP17744631830651560","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/bena/lid2%/predn/myla","code_information":[{"code":"CP17744631830658016","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/benadryl/dexamethasoz","code_information":[{"code":"CP17744631830657807","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine 2%","code_information":[{"code":"CP17744631830658817","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine/alamag","code_information":[{"code":"CP17744631830651017","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine/alamag/bena","code_information":[{"code":"CP17744631830650884","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine/benad","code_information":[{"code":"CP17744631830655319","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/lidocaine/gerilanta","code_information":[{"code":"CP17744631830656576","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/maalox/benadyl 1:1:1","code_information":[{"code":"CP17744631830656469","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/mgoh/diphenhyd/water","code_information":[{"code":"CP17744631830650371","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proparacaine Sol 0.5% Op","code_information":[{"code":"CP17744631830840009","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830872256","type":"CDM"},{"code":"250","type":"RC"},{"code":"93729","type":"CPT","modifier":"56"}],"standard_charges":[{"setting":"outpatient","modifier_code":["56"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830875503","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598050530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830874434","type":"CDM"},{"code":"250","type":"RC"},{"code":"93729","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830874245","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097082507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830872447","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714021302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830877361","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162005710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Raloxifene   Tab 60mg","code_information":[{"code":"CP17744631830874366","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862070901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830870555","type":"CDM"},{"code":"250","type":"RC"},{"code":"45963041806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Trospium Chl Cap 60mg Er","code_information":[{"code":"CP17744631831199265","type":"CDM"},{"code":"250","type":"RC"},{"code":"59136","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Amiloride    Tab 5mg","code_information":[{"code":"CP17744631828465641","type":"CDM"},{"code":"250","type":"RC"},{"code":"57402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amiloride 5mg Tabs","code_information":[{"code":"CP17744631828467295","type":"CDM"},{"code":"250","type":"RC"},{"code":"57402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828512135","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amphet/dextr Cap 15mg Er","code_information":[{"code":"CP17744631828510691","type":"CDM"},{"code":"250","type":"RC"},{"code":"11514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Amphet/dextr Cap 15mg Er","code_information":[{"code":"CP17744631828513376","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Amphet/dextr Cap 15mg Er","code_information":[{"code":"CP17744631828513153","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975033310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828512290","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975033410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828510041","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828510440","type":"CDM"},{"code":"250","type":"RC"},{"code":"43975033610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Amphet/dextr Cap 5mg Er","code_information":[{"code":"CP17744631828518617","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aripiprazole Sol 1mg/ml","code_information":[{"code":"CP17744631828742731","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505040405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aripiprazole Sol 1mg/ml","code_information":[{"code":"CP17744631828743813","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888010020","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Aripiprazole Sol 1mg/ml","code_information":[{"code":"CP17744631828746429","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162089374","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Armour Thyro Tab 30mg","code_information":[{"code":"CP17744631828755770","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Calcipotrien Cre 0.005%","code_information":[{"code":"CP17744631829066308","type":"CDM"},{"code":"250","type":"RC"},{"code":"78171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Lot 0.05%","code_information":[{"code":"CP17744631829262608","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565005504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Lot 0.05%","code_information":[{"code":"CP17744631829264963","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565005502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clotrimazole Tro 10mg","code_information":[{"code":"CP17744631829395465","type":"CDM"},{"code":"250","type":"RC"},{"code":"54414","type":"CPT","modifier":"622"}],"standard_charges":[{"setting":"outpatient","modifier_code":["622"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cuvposa      Sol 1mg/5ml","code_information":[{"code":"CP17744631829435772","type":"CDM"},{"code":"250","type":"RC"},{"code":"25905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Dextroamp-amphet Er 30 Mg Cap","code_information":[{"code":"CP17744631829575135","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Diazepam     Con 5mg/ml","code_information":[{"code":"CP17744631829583613","type":"CDM"},{"code":"250","type":"RC"},{"code":"54318","type":"CPT","modifier":"544"}],"standard_charges":[{"setting":"outpatient","modifier_code":["544"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Levetiraceta Tab 1000mg","code_information":[{"code":"CP17744631830307179","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385095760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Levetiraceta Tab 1000mg","code_information":[{"code":"CP17744631830309665","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862031560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Levetiraceta Tab 1000mg","code_information":[{"code":"CP17744631830303113","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180011507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Levetiraceta Tab 1000mg","code_information":[{"code":"CP17744631830302873","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808026601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Levetiracetam 1000mg Tabs","code_information":[{"code":"CP17744631830303953","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722053960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Lubiprostone Cap 8mcg","code_information":[{"code":"CP17744631830383909","type":"CDM"},{"code":"250","type":"RC"},{"code":"48034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Metolazone   Tab 5mg","code_information":[{"code":"CP17744631830466045","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332053331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metronidazol Cre 0.75%","code_information":[{"code":"CP17744631830471289","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993096045","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Metronidazol Gel 0.75%","code_information":[{"code":"CP17744631830476411","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993096245","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Metronidazol Gel 0.75%","code_information":[{"code":"CP17744631830479940","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672411606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Mirtazapine  Tab 15mg Odt","code_information":[{"code":"CP17744631830496301","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862002106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mirtazapine 15mg Odt","code_information":[{"code":"CP17744631830490742","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862002106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Topiramate   Tab 200mg","code_information":[{"code":"CP17744631831153995","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462011060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tramadol Hcl Tab 100mg","code_information":[{"code":"CP17744631831157448","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817019610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Triam Cre 0.1%-mupirocin-cetap","code_information":[{"code":"CP17744631831177203","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinolon Cre 0.1%","code_information":[{"code":"CP17744631831182595","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinolone 0.1% / Cetaphil","code_information":[{"code":"CP17744631831188930","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valacyclovir Tab 500mg","code_information":[{"code":"CP17744631831217351","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097015305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valacyclovir Tab 500mg","code_information":[{"code":"CP17744631831227094","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097015302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valsart/hctz Tab 160-25mg","code_information":[{"code":"CP17744631831224555","type":"CDM"},{"code":"250","type":"RC"},{"code":"37863","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Zin20/nys/tri0.1/lid3 2:1:1:1","code_information":[{"code":"CP17744631831399780","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zin20/nys/tri0.1/lid3 4:1:1:1","code_information":[{"code":"CP17744631831394219","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adaptic Dressing 3\"x8\" Pads","code_information":[{"code":"CP17744631828343008","type":"CDM"},{"code":"250","type":"RC"},{"code":"56091002015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amox/k Clav  Chw 400mg","code_information":[{"code":"CP17744631828496462","type":"CDM"},{"code":"250","type":"RC"},{"code":"93227","type":"CPT","modifier":"234"}],"standard_charges":[{"setting":"outpatient","modifier_code":["234"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Asperflex    Pad 4-1%","code_information":[{"code":"CP17744631828767055","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399445305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefazolin    Inj 1gm","code_information":[{"code":"CP17744631829146711","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cefazolin 1gm/50mlsod Cl 0.9%","code_information":[{"code":"CP17744631829151378","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567070725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Claritin Rdt Tab 10mg","code_information":[{"code":"CP17744631829249326","type":"CDM"},{"code":"250","type":"RC"},{"code":"11523715701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cloraz Dipot Tab 3.75mg","code_information":[{"code":"CP17744631829380010","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107031901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Contour      Tes Next","code_information":[{"code":"CP17744631829411074","type":"CDM"},{"code":"250","type":"RC"},{"code":"19373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dextroamphet Cap 15mg Er","code_information":[{"code":"CP17744631829585063","type":"CDM"},{"code":"250","type":"RC"},{"code":"40689","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Levetiraceta Tab 1000mg","code_information":[{"code":"CP17744631830309921","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830303267","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571078850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiracetam 1000mg Tabs","code_information":[{"code":"CP17744631830303709","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Lidocaine Menthol Patch  4%/1%","code_information":[{"code":"CP17744631830337284","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399445305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Lorazepam    Con 2mg/ml","code_information":[{"code":"CP17744631830367886","type":"CDM"},{"code":"250","type":"RC"},{"code":"54353","type":"CPT","modifier":"244"}],"standard_charges":[{"setting":"outpatient","modifier_code":["244"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lorazepam 1mg/ml","code_information":[{"code":"CP17744631830361951","type":"CDM"},{"code":"250","type":"RC"},{"code":"54353","type":"CPT","modifier":"244"}],"standard_charges":[{"setting":"outpatient","modifier_code":["244"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Magdelay     Tab 64mg","code_information":[{"code":"CP17744631830392718","type":"CDM"},{"code":"250","type":"RC"},{"code":"10006070013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":64,"type":"ME"}},{"description":"Neuriva Plus Cap","code_information":[{"code":"CP17744631830554526","type":"CDM"},{"code":"250","type":"RC"},{"code":"47865099550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxazepam     Cap 15mg","code_information":[{"code":"CP17744631830702021","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxycodone    Con 100/5ml","code_information":[{"code":"CP17744631830713826","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689002530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830777494","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237021905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830774337","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237021990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830771354","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237021930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830775282","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729002015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830779085","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830775147","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342005407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830779725","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862051205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830772879","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714064502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830770912","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729002016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone Tab 15mg","code_information":[{"code":"CP17744631830773922","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862051290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pyrazinamide Tab 500mg","code_information":[{"code":"CP17744631830858033","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342044711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Simethicone  Cap 180mg","code_information":[{"code":"CP17744631831026339","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Sotalol Af   Tab 160mg","code_information":[{"code":"CP17744631831051463","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385012701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831266548","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Acarbose     Tab 100mg","code_information":[{"code":"CP17744631828159693","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380076006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Acetylcyst   Sol 10%","code_information":[{"code":"CP17744631828263062","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Acetylcysteine 10% Soln Vial","code_information":[{"code":"CP17744631828303047","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323069310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Adhesive Dressing 4x4","code_information":[{"code":"CP17744631828357838","type":"CDM"},{"code":"250","type":"RC"},{"code":"49182","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/valsar Tab 5-320mg","code_information":[{"code":"CP17744631828485128","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/valsar Tab 5-320mg","code_information":[{"code":"CP17744631828481313","type":"CDM"},{"code":"250","type":"RC"},{"code":"37817","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/valsar Tab 5-320mg","code_information":[{"code":"CP17744631828489802","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155084603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cane Tips    Mis 1\"","code_information":[{"code":"CP17744631829104475","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601000720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cane Tips    Mis 7/8\"","code_information":[{"code":"CP17744631829107886","type":"CDM"},{"code":"250","type":"RC"},{"code":"23601000719","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clomiphene   Tab 50mg","code_information":[{"code":"CP17744631829378204","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884070155","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Coq10        Cap 400mg","code_information":[{"code":"CP17744631829419328","type":"CDM"},{"code":"250","type":"RC"},{"code":"35046000434","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Corvita 150  Tab","code_information":[{"code":"CP17744631829425569","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811006610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Cromolyn Sod Neb 20mg/2ml","code_information":[{"code":"CP17744631829434706","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204002860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fenofibrate  Cap 130mg","code_information":[{"code":"CP17744631829859311","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180013106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":130,"type":"ME"}},{"description":"Fluvoxamine  Tab 25mg","code_information":[{"code":"CP17744631829983082","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505016401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Formoterol   Neb 20/2ml","code_information":[{"code":"CP17744631829990485","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858009462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ML"}},{"description":"Furosemide   Inj 20mg/2ml","code_information":[{"code":"CP17744631830005274","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155047341","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Heparin 5000unit/ml Soln","code_information":[{"code":"CP17744631830075129","type":"CDM"},{"code":"250","type":"RC"},{"code":"69005","type":"CPT","modifier":"903"}],"standard_charges":[{"setting":"outpatient","modifier_code":["903"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Heparin Sod  Inj 5000/ml","code_information":[{"code":"CP17744631830073983","type":"CDM"},{"code":"250","type":"RC"},{"code":"69005","type":"CPT","modifier":"903"}],"standard_charges":[{"setting":"outpatient","modifier_code":["903"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Herpecin-l   Mis","code_information":[{"code":"CP17744631830082819","type":"CDM"},{"code":"250","type":"RC"},{"code":"71687077732","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ibuprofen    Tab 800mg","code_information":[{"code":"CP17744631830121336","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162046650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Island Border Dresing 4x4","code_information":[{"code":"CP17744631830168187","type":"CDM"},{"code":"250","type":"RC"},{"code":"16890","type":"CPT","modifier":"44"}],"standard_charges":[{"setting":"outpatient","modifier_code":["44"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Admin Set / Flow Regul","code_information":[{"code":"CP17744631830171708","type":"CDM"},{"code":"250","type":"RC"},{"code":"11450","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Ext Set / Flow Regulat","code_information":[{"code":"CP17744631830172771","type":"CDM"},{"code":"250","type":"RC"},{"code":"25002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketoconazole Cre 2%","code_information":[{"code":"CP17744631830180994","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Nifedipine   Tab 90mg Er","code_information":[{"code":"CP17744631830568579","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979000901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Olm Med/hctz Tab 20-12.5","code_information":[{"code":"CP17744631830670851","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547039109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Olm Med/hctz Tab 20-12.5","code_information":[{"code":"CP17744631830672512","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547039103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830679535","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462043730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830677280","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862074290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830673197","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462043790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830678472","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862074230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pot Chloride Cap 10meq Er","code_information":[{"code":"CP17744631830791876","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180079902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Preparatn H  Cre Rpd Rlf","code_information":[{"code":"CP17744631830822496","type":"CDM"},{"code":"250","type":"RC"},{"code":"57328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Robafen      Liq 200/10ml","code_information":[{"code":"CP17744631830914942","type":"CDM"},{"code":"250","type":"RC"},{"code":"90467","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Salonpas 0.025%-1.25% Patch","code_information":[{"code":"CP17744631830990224","type":"CDM"},{"code":"250","type":"RC"},{"code":"46581087006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Scotch Tape","code_information":[{"code":"CP17744631830991895","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131057634","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sudafed 24hr Tab 240mg","code_information":[{"code":"CP17744631831077328","type":"CDM"},{"code":"250","type":"RC"},{"code":"81960","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Sudafed N/d Pse 24hr","code_information":[{"code":"CP17744631831072646","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580024001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831099328","type":"CDM"},{"code":"250","type":"RC"},{"code":"54288013501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Topiramate   Tab 100mg","code_information":[{"code":"CP17744631831158183","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335071113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Topiramate   Tab 100mg","code_information":[{"code":"CP17744631831155063","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382014014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Topiramate   Tab 100mg","code_information":[{"code":"CP17744631831155634","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382014005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Topiramate 100mg Tabs","code_information":[{"code":"CP17744631831152083","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382014005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831258821","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806060209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 100mg","code_information":[{"code":"CP17744631831254136","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155025001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venlafaxine  Tab 100mg","code_information":[{"code":"CP17744631831251861","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237017601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831264625","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831265134","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834021730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831264904","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722012430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831265313","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877072730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831269419","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980057909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831260742","type":"CDM"},{"code":"250","type":"RC"},{"code":"52726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831265261","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335075983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831268126","type":"CDM"},{"code":"250","type":"RC"},{"code":"52726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831262702","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710134909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Tab 75mg Er","code_information":[{"code":"CP17744631831260692","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834021790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine Er 75mg Tabs","code_information":[{"code":"CP17744631831269992","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"3ml Syringe  Mis 25gx1\"","code_information":[{"code":"CP17744631828097532","type":"CDM"},{"code":"250","type":"RC"},{"code":"13703010391","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Adapalene    Gel 0.3%","code_information":[{"code":"CP17744631828342207","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922005106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Amantadine   Tab 100mg","code_information":[{"code":"CP17744631828452243","type":"CDM"},{"code":"250","type":"RC"},{"code":"42543049701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amantadine 100mg Tabs","code_information":[{"code":"CP17744631828468520","type":"CDM"},{"code":"250","type":"RC"},{"code":"42543049701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amlod/atorva Tab 10-10mg","code_information":[{"code":"CP17744631828474717","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598032130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 10-10mg","code_information":[{"code":"CP17744631828472906","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993027030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 10-10mg","code_information":[{"code":"CP17744631828474922","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762673001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 10-10mg","code_information":[{"code":"CP17744631828474790","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598032190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/atorva Tab 5-10mg","code_information":[{"code":"CP17744631828489431","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762672001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/atorva Tab 5-10mg","code_information":[{"code":"CP17744631828485352","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505347803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cartia Xt    Cap 300/24hr","code_information":[{"code":"CP17744631829136533","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037060090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Cartia Xt    Cap 300/24hr","code_information":[{"code":"CP17744631829133423","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037060005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Clomiphene   Tab 50mg","code_information":[{"code":"CP17744631829379723","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884070154","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clonazep Odt Tab 0.125mg","code_information":[{"code":"CP17744631829377079","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664078386","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Clonazep Odt Tab 0.5mg","code_information":[{"code":"CP17744631829379383","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332036606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clonazep Odt Tab 0.5mg","code_information":[{"code":"CP17744631829371680","type":"CDM"},{"code":"250","type":"RC"},{"code":"93929","type":"CPT","modifier":"267"}],"standard_charges":[{"setting":"outpatient","modifier_code":["267"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clonazepam  Odt Tab 0.125mg","code_information":[{"code":"CP17744631829376806","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664078386","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Clonazepam Odt-0.5mg-tbdp","code_information":[{"code":"CP17744631829377613","type":"CDM"},{"code":"250","type":"RC"},{"code":"93929","type":"CPT","modifier":"267"}],"standard_charges":[{"setting":"outpatient","modifier_code":["267"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Digoxin      Tab 0.125mg","code_information":[{"code":"CP17744631829607355","type":"CDM"},{"code":"250","type":"RC"},{"code":"14312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Digoxin 0.125mg Tabs","code_information":[{"code":"CP17744631829608582","type":"CDM"},{"code":"250","type":"RC"},{"code":"14312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Eye Drops    Sol 0.05% Op","code_information":[{"code":"CP17744631829838216","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocin Acet Cre 0.025%","code_information":[{"code":"CP17744631829961534","type":"CDM"},{"code":"250","type":"RC"},{"code":"71307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Ivermectin   Lot 0.5%","code_information":[{"code":"CP17744631830176036","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672423008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Loxapine     Cap 25mg","code_information":[{"code":"CP17744631830381069","type":"CDM"},{"code":"250","type":"RC"},{"code":"64850089201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methylphenid Tab 10mg","code_information":[{"code":"CP17744631830454447","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084082321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Naproxen Dr  Tab 375mg","code_information":[{"code":"CP17744631830548234","type":"CDM"},{"code":"250","type":"RC"},{"code":"42494045310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830673960","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228034010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830673994","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxybutynin   Tab 5mg","code_information":[{"code":"CP17744631830709990","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954000520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxybutynin Chloride Tab 5mg","code_information":[{"code":"CP17744631830705775","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954000520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pen Needles 5mm 33g","code_information":[{"code":"CP17744631830741666","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014177","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prazosin Hcl Cap 5mg","code_information":[{"code":"CP17744631830819780","type":"CDM"},{"code":"250","type":"RC"},{"code":"93406","type":"CPT","modifier":"901"}],"standard_charges":[{"setting":"outpatient","modifier_code":["901"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tetrahyd Opt Sol .05%","code_information":[{"code":"CP17744631831121776","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Topiramate   Tab 100mg","code_information":[{"code":"CP17744631831153493","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097012403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Trifluoperaz Tab 5mg","code_information":[{"code":"CP17744631831183269","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Acampro Cal  Tab 333mg","code_information":[{"code":"CP17744631828153783","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462043518","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":333,"type":"ME"}},{"description":"Baclofen     Sol 5mg/5ml","code_information":[{"code":"CP17744631828826969","type":"CDM"},{"code":"250","type":"RC"},{"code":"68134040116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Benzonatate  Cap 100mg","code_information":[{"code":"CP17744631828864415","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806071405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Budesonide   Sus 32mcg","code_information":[{"code":"CP17744631828964527","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505612902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Clonazep Odt Tab 0.125mg","code_information":[{"code":"CP17744631829373243","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332036406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Clonazep Odt Tab 0.25mg","code_information":[{"code":"CP17744631829376422","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664078486","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clonazep Odt Tab 0.5mg","code_information":[{"code":"CP17744631829371807","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664078586","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clonazepam  Odt Tab 0.5mg","code_information":[{"code":"CP17744631829379564","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664078586","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diclofenac   Sol 0.1% Op","code_information":[{"code":"CP17744631829594035","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208045705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diltiazem    Cap 180mg Er","code_information":[{"code":"CP17744631829699681","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979002707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Fluphenazine Tab 2.5mg","code_information":[{"code":"CP17744631829986511","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluphenazine Tab 2.5mg","code_information":[{"code":"CP17744631829980564","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluphenazine Tab 2.5mg","code_information":[{"code":"CP17744631829987904","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238167901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluphenazine Tab 2.5mg","code_information":[{"code":"CP17744631829987827","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954027410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Fluphenazine Tab 2.5mg","code_information":[{"code":"CP17744631829981231","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241025401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydroc/homat Tab 5-1.5mg","code_information":[{"code":"CP17744631830095550","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702005503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hyoscyamine  Tab 0.125mg","code_information":[{"code":"CP17744631830127203","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781001301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Ketorolac    Inj 15mg/ml","code_information":[{"code":"CP17744631830199972","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611071925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Larin        Tab 1.5/30","code_information":[{"code":"CP17744631830224884","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830371932","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862046990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Lubricant    Oin Eye Pm","code_information":[{"code":"CP17744631830381789","type":"CDM"},{"code":"250","type":"RC"},{"code":"69618006076","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nadolol      Tab 20mg","code_information":[{"code":"CP17744631830530538","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385013301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Phenytoin Er 200mg Caps","code_information":[{"code":"CP17744631830767633","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756029983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Phenytoin Ex Cap 200mg","code_information":[{"code":"CP17744631830760802","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756029983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tretinoin    Cre 0.025%","code_information":[{"code":"CP17744631831172033","type":"CDM"},{"code":"250","type":"RC"},{"code":"47201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831250920","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722012390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Align Probiotic Chew Tabs","code_information":[{"code":"CP17744631828409156","type":"CDM"},{"code":"250","type":"RC"},{"code":"3700096168","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carb/levo    Tab 10-100mg","code_information":[{"code":"CP17744631829108998","type":"CDM"},{"code":"250","type":"RC"},{"code":"93970","type":"CPT","modifier":"105"}],"standard_charges":[{"setting":"outpatient","modifier_code":["105"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cefdinir     Cap 300mg","code_information":[{"code":"CP17744631829154097","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237009960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cefpodoxime  Tab 100mg","code_information":[{"code":"CP17744631829179765","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714039401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cefpodoxime  Tab 100mg","code_information":[{"code":"CP17744631829170530","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cefpodoxime 100mg Tabs","code_information":[{"code":"CP17744631829173569","type":"CDM"},{"code":"250","type":"RC"},{"code":"78154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829408693","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710135103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829409802","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722089901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829402157","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710135101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829402016","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877058901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829400043","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598037230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829405475","type":"CDM"},{"code":"250","type":"RC"},{"code":"25420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Colchicine   Tab 0.6mg","code_information":[{"code":"CP17744631829403926","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722089930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Cortef       Tab 5mg","code_information":[{"code":"CP17744631829425660","type":"CDM"},{"code":"250","type":"RC"},{"code":"90012","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Danazol      Cap 100mg","code_information":[{"code":"CP17744631829470636","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Desoximetas  Cre 0.25%","code_information":[{"code":"CP17744631829561480","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Diazepam     Tab 5mg","code_information":[{"code":"CP17744631829585104","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079028520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Felbamate    Tab 600mg","code_information":[{"code":"CP17744631829848301","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559073101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Fluocinonide Sol 0.05%","code_information":[{"code":"CP17744631829975451","type":"CDM"},{"code":"250","type":"RC"},{"code":"16801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Glydo        Gel 2%","code_information":[{"code":"CP17744631830051529","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Hydroxychlor Tab 300mg","code_information":[{"code":"CP17744631830117566","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Nitrofur Mac Cap 100mg","code_information":[{"code":"CP17744631830564609","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756041211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830668972","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208043405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxybutynin   Tab 15mg Er","code_information":[{"code":"CP17744631830706617","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729031901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxybutynin   Tab 15mg Er","code_information":[{"code":"CP17744631830707573","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241015704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxybutynin   Tab 15mg Er","code_information":[{"code":"CP17744631830700263","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382025701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxybutynin Er 15mg Tabs","code_information":[{"code":"CP17744631830718057","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729031901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxymorphone  Tab Hcl 10mg","code_information":[{"code":"CP17744631830727551","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702007106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxymorphone Hcl 10mg Tabs","code_information":[{"code":"CP17744631830728657","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722093001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830879877","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241012502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Sod Bicarb   Inj 8.4%","code_information":[{"code":"CP17744631831035618","type":"CDM"},{"code":"250","type":"RC"},{"code":"51754501104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":84,"type":"EA"}},{"description":"Suture Removal Kit Steril","code_information":[{"code":"CP17744631831089370","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784045212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Verapamil    Tab 40mg","code_information":[{"code":"CP17744631831262799","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155005901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Verapamil 40mg Tabs","code_information":[{"code":"CP17744631831263099","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155005901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Amlod/olmesa Tab 10-40mg","code_information":[{"code":"CP17744631828486180","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664077583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole 10mg Tabs","code_information":[{"code":"CP17744631828742982","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole 15mg Tabs","code_information":[{"code":"CP17744631828749931","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aripiprazole 2mg Tabs","code_information":[{"code":"CP17744631828746531","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aripiprazole 5mg Tabs","code_information":[{"code":"CP17744631828746831","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aripiprazole Tab 10mg","code_information":[{"code":"CP17744631828741402","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162089809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg","code_information":[{"code":"CP17744631828749397","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg","code_information":[{"code":"CP17744631828746472","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg","code_information":[{"code":"CP17744631828741442","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598096730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg","code_information":[{"code":"CP17744631828746231","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 10mg","code_information":[{"code":"CP17744631828746032","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729028001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Aripiprazole Tab 15mg","code_information":[{"code":"CP17744631828748537","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547030503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aripiprazole Tab 15mg","code_information":[{"code":"CP17744631828748164","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aripiprazole Tab 15mg","code_information":[{"code":"CP17744631828746825","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Aripiprazole Tab 20mg","code_information":[{"code":"CP17744631828749704","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Aripiprazole Tab 20mg","code_information":[{"code":"CP17744631828743882","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162090109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Aripiprazole Tab 20mg","code_information":[{"code":"CP17744631828747358","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714014501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Aripiprazole Tab 20mg","code_information":[{"code":"CP17744631828743965","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Aripiprazole Tab 2mg","code_information":[{"code":"CP17744631828741667","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714014101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aripiprazole Tab 2mg","code_information":[{"code":"CP17744631828746489","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332009730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aripiprazole Tab 2mg","code_information":[{"code":"CP17744631828744772","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668021605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aripiprazole Tab 2mg","code_information":[{"code":"CP17744631828747613","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aripiprazole Tab 2mg","code_information":[{"code":"CP17744631828740630","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aripiprazole Tab 2mg","code_information":[{"code":"CP17744631828746455","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Aripiprazole Tab 5mg","code_information":[{"code":"CP17744631828758298","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714078401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aripiprazole Tab 5mg","code_information":[{"code":"CP17744631828752676","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668021705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Aripiprazole Tab 5mg","code_information":[{"code":"CP17744631828750655","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877043103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Batteries 2032","code_information":[{"code":"CP17744631828847022","type":"CDM"},{"code":"250","type":"RC"},{"code":"3980003280","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Batteries Size 312 Hearing-aid","code_information":[{"code":"CP17744631828849254","type":"CDM"},{"code":"250","type":"RC"},{"code":"49022051191","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Biosite Valve Clear","code_information":[{"code":"CP17744631828886517","type":"CDM"},{"code":"250","type":"RC"},{"code":"7000008000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carbamazepin Cap 200mg Er","code_information":[{"code":"CP17744631829110014","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033002012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829223366","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806026695","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Cholestyramine/aquaphor","code_information":[{"code":"CP17744631829224974","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806026695","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cholestyramine-4gm-pack","code_information":[{"code":"CP17744631829224732","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806026695","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Claritin-d   Tab 5-120mg","code_information":[{"code":"CP17744631829242283","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100080217","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clobetasol   Spr 0.05%","code_information":[{"code":"CP17744631829368670","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332042559","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Spr 0.05%","code_information":[{"code":"CP17744631829362386","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462048039","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clotrimazole Sol 1%","code_information":[{"code":"CP17744631829394411","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817080030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclosporine Sol Modified","code_information":[{"code":"CP17744631829444748","type":"CDM"},{"code":"250","type":"RC"},{"code":"17273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dorzolamide  Sol 2% Op","code_information":[{"code":"CP17744631829723409","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377008111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Dorzolamide  Sol 2% Op","code_information":[{"code":"CP17744631829723969","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383023210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829756455","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine Hcl Cap 30mg","code_information":[{"code":"CP17744631829750574","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ekit","code_information":[{"code":"CP17744631829764208","type":"CDM"},{"code":"DRG","type":"RC"},{"code":"006","type":"DRG"}],"standard_charges":[{"setting":"inpatient","gross_charge":1,"discounted_cash":1}]},{"description":"Elastic Bandage 6\"","code_information":[{"code":"CP17744631829762227","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784036662","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eplerenone 25mg Tabs","code_information":[{"code":"CP17744631829790615","type":"CDM"},{"code":"250","type":"RC"},{"code":"37810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Gentamicin   Inj 10mg/ml","code_information":[{"code":"CP17744631830027254","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150040125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hear Aid Bat Mis Size 312","code_information":[{"code":"CP17744631830073436","type":"CDM"},{"code":"250","type":"RC"},{"code":"49022051191","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Sod  Inj 5000/ml","code_information":[{"code":"CP17744631830083487","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603041225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Heparin Sod  Inj 5000/ml","code_information":[{"code":"CP17744631830089206","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323026201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Iv Pumpsapphire Cadd","code_information":[{"code":"CP17744631830171796","type":"CDM"},{"code":"250","type":"RC"},{"code":"15031000028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Pump Cadd","code_information":[{"code":"CP17744631830177222","type":"CDM"},{"code":"250","type":"RC"},{"code":"32368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Pump Spectrum","code_information":[{"code":"CP17744631830175757","type":"CDM"},{"code":"250","type":"RC"},{"code":"21610","type":"CPT","modifier":"58"}],"standard_charges":[{"setting":"outpatient","modifier_code":["58"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacosamide   Sol 10mg/ml","code_information":[{"code":"CP17744631830209717","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722062726","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Levetiraceta Tab 750mg Er","code_information":[{"code":"CP17744631830304940","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180011807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiraceta Tab 750mg Er","code_information":[{"code":"CP17744631830302578","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505351706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiraceta Tab 750mg Er","code_information":[{"code":"CP17744631830304327","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547034606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiraceta Tab 750mg Er","code_information":[{"code":"CP17744631830300370","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228019060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levofloxacin 250mg Tabs","code_information":[{"code":"CP17744631830309815","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722072150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 250mg","code_information":[{"code":"CP17744631830307290","type":"CDM"},{"code":"250","type":"RC"},{"code":"90463","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 250mg","code_information":[{"code":"CP17744631830305243","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722072150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 250mg","code_information":[{"code":"CP17744631830305281","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862053650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 250mg","code_information":[{"code":"CP17744631830317269","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578009818","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 250mg","code_information":[{"code":"CP17744631830312027","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342002108","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 250mg","code_information":[{"code":"CP17744631830317920","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111027950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Levofloxacin Tab 500mg","code_information":[{"code":"CP17744631830315340","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342002208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levofloxacin Tab 750mg","code_information":[{"code":"CP17744631830316365","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111028130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levofloxacin Tab 750mg","code_information":[{"code":"CP17744631830311914","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722072320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levofloxacin Tab 750mg","code_information":[{"code":"CP17744631830317196","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578010092","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levofloxacin Tab 750mg","code_information":[{"code":"CP17744631830313986","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342002332","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levoxyl      Tab 88mcg","code_information":[{"code":"CP17744631830324990","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793085301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":88,"type":"ME"}},{"description":"Lidocaine    Cre 4%","code_information":[{"code":"CP17744631830336429","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328002415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"L-methylfola Tab 7.5mg","code_information":[{"code":"CP17744631830352274","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991080833","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Lubiprostone Cap 24mcg","code_information":[{"code":"CP17744631830385582","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162084206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Lubiprostone Cap 24mcg","code_information":[{"code":"CP17744631830388195","type":"CDM"},{"code":"250","type":"RC"},{"code":"25430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Lubiprostone Cap 8mcg","code_information":[{"code":"CP17744631830382432","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304035160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Lubiprostone Cap 8mcg","code_information":[{"code":"CP17744631830383893","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710164106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Melatonin    Tab 5mg","code_information":[{"code":"CP17744631830413615","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333052010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Midazolam    Inj 5mg/ml","code_information":[{"code":"CP17744631830483563","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nateglinide  Tab 60mg","code_information":[{"code":"CP17744631830541481","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834020501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Olanzapine   Tab 10mg","code_information":[{"code":"CP17744631830668543","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505311308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 10mg","code_information":[{"code":"CP17744631830668773","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 10mg","code_information":[{"code":"CP17744631830664555","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 10mg","code_information":[{"code":"CP17744631830665069","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine   Tab 15mg","code_information":[{"code":"CP17744631830663921","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 15mg","code_information":[{"code":"CP17744631830662222","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505311400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Olanzapine   Tab 2.5mg","code_information":[{"code":"CP17744631830668272","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993068030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olanzapine   Tab 2.5mg","code_information":[{"code":"CP17744631830662266","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olanzapine   Tab 2.5mg","code_information":[{"code":"CP17744631830661292","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olanzapine   Tab 5mg","code_information":[{"code":"CP17744631830664749","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342006844","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine   Tab 5mg","code_information":[{"code":"CP17744631830660110","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine   Tab 7.5mg","code_information":[{"code":"CP17744631830667425","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Olanzapine 10mg Tabs","code_information":[{"code":"CP17744631830663735","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505311308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine 10mg Tabs","code_information":[{"code":"CP17744631830664760","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine 10mg Tabs","code_information":[{"code":"CP17744631830660686","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine 10mg Tabs","code_information":[{"code":"CP17744631830669596","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Olanzapine 2.5mg Tabs","code_information":[{"code":"CP17744631830667673","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505311008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olanzapine 2.5mg Tabs","code_information":[{"code":"CP17744631830669933","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olanzapine 2.5mg Tabs","code_information":[{"code":"CP17744631830663499","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olanzapine 5mg Tabs","code_information":[{"code":"CP17744631830673767","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olanzapine 7.5mg Tabs","code_information":[{"code":"CP17744631830671691","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543038290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Olanzapine Tab 2.5mg","code_information":[{"code":"CP17744631830670469","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111016330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830674263","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069001701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Proben/colch Tab 500-0.5","code_information":[{"code":"CP17744631830830021","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742026301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Quetiapine   Tab 150mg","code_information":[{"code":"CP17744631830863484","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571080901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Quetiapine   Tab 300mg","code_information":[{"code":"CP17744631830869042","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714045601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg","code_information":[{"code":"CP17744631830864348","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729014912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg","code_information":[{"code":"CP17744631830866234","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300015101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg","code_information":[{"code":"CP17744631830863239","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335090686","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 300mg","code_information":[{"code":"CP17744631830866586","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877024710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine   Tab 400mg","code_information":[{"code":"CP17744631830862940","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714038001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quetiapine   Tab 400mg","code_information":[{"code":"CP17744631830868231","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714045701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Quetiapine 300mg Tabs","code_information":[{"code":"CP17744631830860555","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877024710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine 300mg Tabs","code_information":[{"code":"CP17744631830862256","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714045601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine 300mg Tabs","code_information":[{"code":"CP17744631830863781","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729014912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Quetiapine 400mg Tabs","code_information":[{"code":"CP17744631830860315","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714045701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Ramipril     Cap 10mg","code_information":[{"code":"CP17744631830878574","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862047701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Retin-a      Cre 0.1%","code_information":[{"code":"CP17744631830895673","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Retin-a      Cre 0.1%","code_information":[{"code":"CP17744631830899822","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rolaids Ex Strng Mint 3x","code_information":[{"code":"CP17744631830912109","type":"CDM"},{"code":"250","type":"RC"},{"code":"72011200451","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Saccharomyce Cap Boulardi","code_information":[{"code":"CP17744631830923598","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333080025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sildenafil   Tab 20mg","code_information":[{"code":"CP17744631831011460","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722077690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sildenafil   Tab 20mg","code_information":[{"code":"CP17744631831017083","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668018590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sildenafil   Tab 20mg","code_information":[{"code":"CP17744631831013804","type":"CDM"},{"code":"250","type":"RC"},{"code":"37816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sildenafil   Tab 20mg","code_information":[{"code":"CP17744631831014070","type":"CDM"},{"code":"250","type":"RC"},{"code":"93551","type":"CPT","modifier":"798"}],"standard_charges":[{"setting":"outpatient","modifier_code":["798"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sildenafil Solution","code_information":[{"code":"CP17744631831011340","type":"CDM"},{"code":"250","type":"RC"},{"code":"93551","type":"CPT","modifier":"798"}],"standard_charges":[{"setting":"outpatient","modifier_code":["798"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tramadol Hcl Tab 100mg Er","code_information":[{"code":"CP17744631831161432","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370022111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Valsart/hctz Tab 160-12.5","code_information":[{"code":"CP17744631831226297","type":"CDM"},{"code":"250","type":"RC"},{"code":"37863","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Zafirlukast  Tab 10mg","code_information":[{"code":"CP17744631831392367","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884054902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Adapalene    Gel 0.3%","code_information":[{"code":"CP17744631828341553","type":"CDM"},{"code":"250","type":"RC"},{"code":"47201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Ampicillin   Inj 500mg","code_information":[{"code":"CP17744631828522530","type":"CDM"},{"code":"250","type":"RC"},{"code":"44567010110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Colestipol   Gra 5gm","code_information":[{"code":"CP17744631829403035","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762026002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Contour      Tes Bld Gluc","code_information":[{"code":"CP17744631829415642","type":"CDM"},{"code":"250","type":"RC"},{"code":"19370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluocin Acet Oin 0.025%","code_information":[{"code":"CP17744631829964036","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydroco/apap Tab 7.5-325","code_information":[{"code":"CP17744631830105001","type":"CDM"},{"code":"250","type":"RC"},{"code":"40601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"L-methylfola Tab 15mg","code_information":[{"code":"CP17744631830351443","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991080990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Metronidazol Lot 0.75%","code_information":[{"code":"CP17744631830472353","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Trazodone    Tab 300mg","code_information":[{"code":"CP17744631831163005","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505265901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Trazodone 300mg Tabs","code_information":[{"code":"CP17744631831169434","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505265901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Urethr Cath  Mis 16fr-16\"","code_information":[{"code":"CP17744631831217635","type":"CDM"},{"code":"250","type":"RC"},{"code":"8011009416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Urethral Catheter Bard","code_information":[{"code":"CP17744631831216961","type":"CDM"},{"code":"250","type":"RC"},{"code":"32826","type":"CPT","modifier":"9"}],"standard_charges":[{"setting":"outpatient","modifier_code":["9"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valsartan    Tab 160mg","code_information":[{"code":"CP17744631831220927","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162083909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Valsartan    Tab 320mg","code_information":[{"code":"CP17744631831224648","type":"CDM"},{"code":"250","type":"RC"},{"code":"37858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Valsartan    Tab 320mg","code_information":[{"code":"CP17744631831228727","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291085990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Valsartan 320mg Tabs","code_information":[{"code":"CP17744631831220782","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Zonisamide   Cap 50mg","code_information":[{"code":"CP17744631831415184","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300042901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Acetaminophe Tab 325mg","code_information":[{"code":"CP17744631828200352","type":"CDM"},{"code":"250","type":"RC"},{"code":"90467","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Aripiprazole Sol 1mg/ml","code_information":[{"code":"CP17744631828749294","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603044501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Atovaquone   Sus 750/5ml","code_information":[{"code":"CP17744631828797180","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702022321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Betameth Val Aer 0.12%","code_information":[{"code":"CP17744631828876665","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Betameth Val Aer 0.12%","code_information":[{"code":"CP17744631828870607","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742031550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Claritin     Cap 10mg","code_information":[{"code":"CP17744631829244422","type":"CDM"},{"code":"250","type":"RC"},{"code":"11523720001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Claritin     Chw 5mg","code_information":[{"code":"CP17744631829240486","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100082067","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Clobetasol   Aer 0.05%","code_information":[{"code":"CP17744631829267488","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043732","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Colestipol   Tab 1gm","code_information":[{"code":"CP17744631829405368","type":"CDM"},{"code":"250","type":"RC"},{"code":"11552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Colestipol 1gm Tabs","code_information":[{"code":"CP17744631829407814","type":"CDM"},{"code":"250","type":"RC"},{"code":"11552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cyclobenzapr Tab 7.5mg","code_information":[{"code":"CP17744631829433311","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300041401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Doxercalcif  Inj 4mcg/2ml","code_information":[{"code":"CP17744631829738663","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150035950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fluconazole  Tab 100mg","code_information":[{"code":"CP17744631829963171","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Foley Cath   Mis 2-way","code_information":[{"code":"CP17744631829998573","type":"CDM"},{"code":"250","type":"RC"},{"code":"8011016520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketorolac    Inj 30mg/ml","code_information":[{"code":"CP17744631830195983","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332060025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ketorolac    Inj 30mg/ml","code_information":[{"code":"CP17744631830194021","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603016125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lamotrigine Er 25mg Tabs","code_information":[{"code":"CP17744631830214655","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lidocaine    Cre 5%","code_information":[{"code":"CP17744631830339581","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328002530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830673020","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877044690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxycod/apap  Tab 2.5-325","code_information":[{"code":"CP17744631830713106","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722094801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Oxycodone/apap 2.5-325mg Tab","code_information":[{"code":"CP17744631830719933","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722094801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pindolol     Tab 5mg","code_information":[{"code":"CP17744631830772676","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033002801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Refresh      Sol Optive","code_information":[{"code":"CP17744631830886842","type":"CDM"},{"code":"250","type":"RC"},{"code":"23430","type":"CPT","modifier":"710"}],"standard_charges":[{"setting":"outpatient","modifier_code":["710"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Refresh Optive Advanced","code_information":[{"code":"CP17744631830884547","type":"CDM"},{"code":"250","type":"RC"},{"code":"23430","type":"CPT","modifier":"710"}],"standard_charges":[{"setting":"outpatient","modifier_code":["710"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Oin 0.03%","code_information":[{"code":"CP17744631831095040","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802039001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Topiramate   Tab 100mg","code_information":[{"code":"CP17744631831152326","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097012412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Xeroform 4\"x4\" Pad","code_information":[{"code":"CP17744631831386022","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080433501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xerofrm Petr Pad 4\"x4\"","code_information":[{"code":"CP17744631831386187","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080433501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xerofrm Petr Pad 4\"x4\" #2206","code_information":[{"code":"CP17744631831385064","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080433501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amox/k Clav  Tab 250-125","code_information":[{"code":"CP17744631828500773","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714029501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Capecitabine Tab 500mg","code_information":[{"code":"CP17744631829102355","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097094808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cdp/amitrip  Tab 5-12.5mg","code_information":[{"code":"CP17744631829141962","type":"CDM"},{"code":"250","type":"RC"},{"code":"37802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Desoximetas  Cre 0.25%","code_information":[{"code":"CP17744631829565513","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Desoximetas  Oin 0.25%","code_information":[{"code":"CP17744631829563798","type":"CDM"},{"code":"250","type":"RC"},{"code":"47204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Estra/noreth Tab 0.5-0.1","code_information":[{"code":"CP17744631829810125","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742065828","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fenofibrate  Cap 134mg","code_information":[{"code":"CP17744631829850751","type":"CDM"},{"code":"250","type":"RC"},{"code":"11505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":134,"type":"ME"}},{"description":"First Aid    Kit To Go","code_information":[{"code":"CP17744631829958091","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137008295","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Firvanq      Sol 50mg/ml","code_information":[{"code":"CP17744631829959862","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628020810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fusion Plus  Cap","code_information":[{"code":"CP17744631830012242","type":"CDM"},{"code":"250","type":"RC"},{"code":"52747050230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medical Tape Nonsterile","code_information":[{"code":"CP17744631830406204","type":"CDM"},{"code":"250","type":"RC"},{"code":"45553200010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Megared Omga 3 500mg Caps","code_information":[{"code":"CP17744631830411695","type":"CDM"},{"code":"250","type":"RC"},{"code":"20525010446","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Morphine Sul Tab 100mg Er","code_information":[{"code":"CP17744631830507131","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858080401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Olopatadine  Dro 0.1%","code_information":[{"code":"CP17744631830673682","type":"CDM"},{"code":"250","type":"RC"},{"code":"51407049905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paroxetine   Tab 10mg","code_information":[{"code":"CP17744631830733944","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382009710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pindolol     Tab 5mg","code_information":[{"code":"CP17744631830771721","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664065588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Testosterone Gel 1%(50mg)","code_information":[{"code":"CP17744631831110972","type":"CDM"},{"code":"250","type":"RC"},{"code":"83211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Valsartan    Tab 320mg","code_information":[{"code":"CP17744631831229876","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547037009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Alaway       Dro 0.025%op","code_information":[{"code":"CP17744631828373745","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208060110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuked 25   Inj 25%","code_information":[{"code":"CP17744631828370916","type":"CDM"},{"code":"250","type":"RC"},{"code":"76125079225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Albuked 25   Inj 25%","code_information":[{"code":"CP17744631828372771","type":"CDM"},{"code":"250","type":"RC"},{"code":"76125079210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Banatrol     Pak Plus","code_information":[{"code":"CP17744631828833497","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688008475","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clobetasol   Aer 0.05%","code_information":[{"code":"CP17744631829267322","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742030401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Aer 0.05%","code_information":[{"code":"CP17744631829268965","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462060894","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol Prop 0.05% Foam","code_information":[{"code":"CP17744631829366774","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462060894","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cloraz Dipot Tab 7.5mg","code_information":[{"code":"CP17744631829386300","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Diltiazem    Cap 90mg Er","code_information":[{"code":"CP17744631829690361","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462085101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Gnp Lidocain Pad 4%","code_information":[{"code":"CP17744631830055975","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122045021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ipratropium  Spr 0.06%","code_information":[{"code":"CP17744631830158043","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505082701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Ipratropium  Spr 0.06%","code_information":[{"code":"CP17744631830155275","type":"CDM"},{"code":"250","type":"RC"},{"code":"54004","type":"CPT","modifier":"641"}],"standard_charges":[{"setting":"outpatient","modifier_code":["641"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Lidocaine 4% Patch","code_information":[{"code":"CP17744631830338432","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122045021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Miconazole 7 Sup 100mg","code_information":[{"code":"CP17744631830484925","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269073607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Naproxen     Tab 375mg","code_information":[{"code":"CP17744631830531898","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162018910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Pravastatin  Tab 10mg","code_information":[{"code":"CP17744631830802982","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111022990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pravastatin 10mg Tabs","code_information":[{"code":"CP17744631830801308","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111022990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830876211","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462031960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830876406","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578006414","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ranolazine   Tab 500mg Er","code_information":[{"code":"CP17744631830874101","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756070360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Sulfasalazin Tab 500mg","code_information":[{"code":"CP17744631831077646","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762500005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Terconazole  Cre 0.4%","code_information":[{"code":"CP17744631831113948","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Acetaminophe Inj 1000mg","code_information":[{"code":"CP17744631828195570","type":"CDM"},{"code":"250","type":"RC"},{"code":"14393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Aluminum Ace Pow Astringn","code_information":[{"code":"CP17744631828452951","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224016212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amiodarone   Tab 400mg","code_information":[{"code":"CP17744631828472230","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Aveeno Bath  Pak Treatmnt","code_information":[{"code":"CP17744631828804294","type":"CDM"},{"code":"250","type":"RC"},{"code":"8137003662","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betameth Dip Oin 0.05%","code_information":[{"code":"CP17744631828875579","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bupropion    Tab 100mg","code_information":[{"code":"CP17744631828982434","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505015701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Bupropion 100mg Tabs","code_information":[{"code":"CP17744631828997659","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505015701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"But/asa/caff Cap","code_information":[{"code":"CP17744631829047414","type":"CDM"},{"code":"250","type":"RC"},{"code":"52715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Butal/asa/caff 50/325/40mg Cap","code_information":[{"code":"CP17744631829044955","type":"CDM"},{"code":"250","type":"RC"},{"code":"52715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Butalb/aspiri/c 50-325-40 Cap","code_information":[{"code":"CP17744631829047730","type":"CDM"},{"code":"250","type":"RC"},{"code":"52715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Carb/levo    Tab 25-250mg","code_information":[{"code":"CP17744631829104865","type":"CDM"},{"code":"250","type":"RC"},{"code":"22825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carbidopa/levodopa 25-250mg Tb","code_information":[{"code":"CP17744631829122830","type":"CDM"},{"code":"250","type":"RC"},{"code":"22825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Chlord/clidi Cap 5-2.5mg","code_information":[{"code":"CP17744631829217736","type":"CDM"},{"code":"250","type":"RC"},{"code":"11534019701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829226047","type":"CDM"},{"code":"250","type":"RC"},{"code":"18509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Cholestyramine 4gm Pack","code_information":[{"code":"CP17744631829222259","type":"CDM"},{"code":"250","type":"RC"},{"code":"18509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Cloraz Dipot Tab 15mg","code_information":[{"code":"CP17744631829386398","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Clozapine    Tab 200mg","code_information":[{"code":"CP17744631829391926","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664021188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Clozapine    Tab 200mg","code_information":[{"code":"CP17744631829390538","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862084701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Clozapine 200mg Tabs","code_information":[{"code":"CP17744631829391286","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664021188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cold/hot     Pad 5%","code_information":[{"code":"CP17744631829404113","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desipramine  Tab 100mg","code_information":[{"code":"CP17744631829564408","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742011601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Desmopressin Tab 0.2mg","code_information":[{"code":"CP17744631829560330","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505025801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Diltiazem    Cap 90mg Er","code_information":[{"code":"CP17744631829693623","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979018201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Diltiazem Er Tab 180mg","code_information":[{"code":"CP17744631829690176","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436019606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Famciclovir  Tab 250mg","code_information":[{"code":"CP17744631829839724","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722070730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Famciclovir  Tab 250mg","code_information":[{"code":"CP17744631829830903","type":"CDM"},{"code":"250","type":"RC"},{"code":"93811","type":"CPT","modifier":"856"}],"standard_charges":[{"setting":"outpatient","modifier_code":["856"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Felbamate    Tab 600mg","code_information":[{"code":"CP17744631829846563","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781063001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Galantamine  Cap 16mg Er","code_information":[{"code":"CP17744631830010846","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335083683","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Galantamine  Cap 24mg Er","code_information":[{"code":"CP17744631830019840","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335083783","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Galantamine  Cap 8mg Er","code_information":[{"code":"CP17744631830018605","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335083583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Galantamine 24mg Caps","code_information":[{"code":"CP17744631830023548","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335083783","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":24,"type":"ME"}},{"description":"Labetalol    Inj 20/4ml","code_information":[{"code":"CP17744631830195868","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ML"}},{"description":"Metronidazol Pow","code_information":[{"code":"CP17744631830472005","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779014601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Multigen     Tab","code_information":[{"code":"CP17744631830520372","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991054390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830533506","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335032683","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nortrel      Tab 1/35","code_information":[{"code":"CP17744631830579743","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenazopyrid Tab 200mg","code_information":[{"code":"CP17744631830758886","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367016304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Systane Ultr Sol","code_information":[{"code":"CP17744631831094260","type":"CDM"},{"code":"250","type":"RC"},{"code":"65143","type":"CPT","modifier":"128"}],"standard_charges":[{"setting":"outpatient","modifier_code":["128"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thyroid      Tab 90mg","code_information":[{"code":"CP17744631831122880","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559074301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Triamcinolon Aer 55mcg/ac","code_information":[{"code":"CP17744631831170434","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802010901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":55,"type":"ME"}},{"description":"Valsartan    Tab 320mg","code_information":[{"code":"CP17744631831220765","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862057390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Vaseline Gauze 3\" X18\"","code_information":[{"code":"CP17744631831251755","type":"CDM"},{"code":"250","type":"RC"},{"code":"88441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alclometason Cre 0.05%","code_information":[{"code":"CP17744631828395862","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Allegra-d    Tab 12 Hour","code_information":[{"code":"CP17744631828418535","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167431004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Allegra-d    Tab 12 Hour","code_information":[{"code":"CP17744631828413053","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167431006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupropion Xl 300mg Tabs","code_information":[{"code":"CP17744631828994528","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828994518","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828992140","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828991980","type":"CDM"},{"code":"250","type":"RC"},{"code":"77771014530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cyclophosph  Cap 25mg","code_information":[{"code":"CP17744631829446800","type":"CDM"},{"code":"250","type":"RC"},{"code":"54879002101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diethylprop  Tab 75mg Er","code_information":[{"code":"CP17744631829602336","type":"CDM"},{"code":"250","type":"RC"},{"code":"52714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Fenofibrate  Cap 200mg","code_information":[{"code":"CP17744631829854947","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332008631","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Fq Protectiv Mis Xl","code_information":[{"code":"CP17744631829995012","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891050003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hc Valerate  Cre 0.2%","code_information":[{"code":"CP17744631830078984","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802045537","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Heparin Sod  Inj 1000/ml","code_information":[{"code":"CP17744631830074156","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739092025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Levothyroxin Tab 137mcg","code_information":[{"code":"CP17744631830316001","type":"CDM"},{"code":"250","type":"RC"},{"code":"37818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":137,"type":"ME"}},{"description":"Methadone    Tab 5mg","code_information":[{"code":"CP17744631830443506","type":"CDM"},{"code":"250","type":"RC"},{"code":"54070","type":"CPT","modifier":"925"}],"standard_charges":[{"setting":"outpatient","modifier_code":["925"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Methazolamid Tab 25mg","code_information":[{"code":"CP17744631830443877","type":"CDM"},{"code":"250","type":"RC"},{"code":"57407","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Midodrine    Tab 5mg","code_information":[{"code":"CP17744631830483761","type":"CDM"},{"code":"250","type":"RC"},{"code":"37819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Midodrine 5mg Tabs","code_information":[{"code":"CP17744631830485649","type":"CDM"},{"code":"250","type":"RC"},{"code":"37819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nexium 24hr  Tab 20mg","code_information":[{"code":"CP17744631830556439","type":"CDM"},{"code":"250","type":"RC"},{"code":"57324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Olm Med/hctz Tab 20-12.5","code_information":[{"code":"CP17744631830675069","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756081230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Olm Med/hctz Tab 20-12.5","code_information":[{"code":"CP17744631830677490","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668025130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Olmesa Medox Tab 20mg","code_information":[{"code":"CP17744631830673111","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342017910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Onetouch     Tes Verio","code_information":[{"code":"CP17744631830692569","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885027025","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Tes Verio","code_information":[{"code":"CP17744631830699009","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885027150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxybutynin   Tab 10mg Er","code_information":[{"code":"CP17744631830707522","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162037250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxybutynin   Tab 5mg Er","code_information":[{"code":"CP17744631830700113","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162037110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pseudoephedr Tab 30mg","code_information":[{"code":"CP17744631830854465","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802043262","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Renal        Cap","code_information":[{"code":"CP17744631830883767","type":"CDM"},{"code":"250","type":"RC"},{"code":"60258016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Saccharomyce Cap Boulardi","code_information":[{"code":"CP17744631830924761","type":"CDM"},{"code":"250","type":"RC"},{"code":"77333080050","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Trazodone    Tab 300mg","code_information":[{"code":"CP17744631831163845","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668033301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Valsartan    Tab 320mg","code_information":[{"code":"CP17744631831222116","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746036390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Velivet      Pak","code_information":[{"code":"CP17744631831256986","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venlafaxine  Cap 150mg Er","code_information":[{"code":"CP17744631831256574","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806060305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831257052","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722012330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"35 Inch Tubing Admin Set","code_information":[{"code":"CP17744631828078871","type":"CDM"},{"code":"250","type":"RC"},{"code":"35100000000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/valsar Tab 10-160mg","code_information":[{"code":"CP17744631828482752","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155084503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/valsar Tab 10-160mg","code_information":[{"code":"CP17744631828482909","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/valsar Tab 10-160mg","code_information":[{"code":"CP17744631828485858","type":"CDM"},{"code":"250","type":"RC"},{"code":"37817","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Astepro      Spr 205.5mcg","code_information":[{"code":"CP17744631828778333","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100058990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2055,"type":"ME"}},{"description":"Bd Vacutainer Transfer","code_information":[{"code":"CP17744631828849227","type":"CDM"},{"code":"250","type":"RC"},{"code":"36488","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desonide     Lot 0.05%","code_information":[{"code":"CP17744631829562035","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexamethason Tab 2mg","code_information":[{"code":"CP17744631829577618","type":"CDM"},{"code":"250","type":"RC"},{"code":"54418","type":"CPT","modifier":"325"}],"standard_charges":[{"setting":"outpatient","modifier_code":["325"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Doxepin Hcl  Cap 75mg","code_information":[{"code":"CP17744631829737137","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756042711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830215368","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382001005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lido Visc 2%/ Diphen/ Nystat","code_information":[{"code":"CP17744631830324544","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135071242","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Sol 2% Oral","code_information":[{"code":"CP17744631830334552","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135071242","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"L-methylfola Tab 7.5mg","code_information":[{"code":"CP17744631830359034","type":"CDM"},{"code":"250","type":"RC"},{"code":"76439035930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Moexipril    Tab 15mg","code_information":[{"code":"CP17744631830497160","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462020801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Morphine Sul Tab 60mg Er","code_information":[{"code":"CP17744631830505338","type":"CDM"},{"code":"250","type":"RC"},{"code":"40683","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Morphine Sul Tab 60mg Er","code_information":[{"code":"CP17744631830501601","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304075801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Omeprazole   Tab 20mg","code_information":[{"code":"CP17744631830687634","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660002944","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Omeprazole   Tab 20mg Dr","code_information":[{"code":"CP17744631830689933","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660002944","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sulfacet Sod Sol 10% Op","code_information":[{"code":"CP17744631831072018","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314070101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Tacrolimus   Oin 0.03%","code_information":[{"code":"CP17744631831090506","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802039000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Telfa Island Dressing 4x5","code_information":[{"code":"CP17744631831109016","type":"CDM"},{"code":"250","type":"RC"},{"code":"10975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Utymax       Pak","code_information":[{"code":"CP17744631831218773","type":"CDM"},{"code":"250","type":"RC"},{"code":"94688001770","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831253980","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980057803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831259642","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831253353","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811071230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831255091","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714090301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831255393","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335076083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5 Er","code_information":[{"code":"CP17744631831253212","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710134803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Xeroform 4\"x4\" Dressing","code_information":[{"code":"CP17744631831389101","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784035325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xeroform 4\"x4\" Pads","code_information":[{"code":"CP17744631831382024","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784035325","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828519792","type":"CDM"},{"code":"250","type":"RC"},{"code":"52755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amphet/dextr Cap 10mg Er","code_information":[{"code":"CP17744631828519211","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664033788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amphet/dextr Cap 15mg Er","code_information":[{"code":"CP17744631828516033","type":"CDM"},{"code":"250","type":"RC"},{"code":"52707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828513236","type":"CDM"},{"code":"250","type":"RC"},{"code":"64850051301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828512564","type":"CDM"},{"code":"250","type":"RC"},{"code":"52755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amphet/dextr Cap 20mg Er","code_information":[{"code":"CP17744631828512429","type":"CDM"},{"code":"250","type":"RC"},{"code":"52707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Amphet/dextr Cap 25mg Er","code_information":[{"code":"CP17744631828518591","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664034088","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amphet/dextr Cap 25mg Er","code_information":[{"code":"CP17744631828513212","type":"CDM"},{"code":"250","type":"RC"},{"code":"52707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828510987","type":"CDM"},{"code":"250","type":"RC"},{"code":"52755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828518363","type":"CDM"},{"code":"250","type":"RC"},{"code":"52707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828511686","type":"CDM"},{"code":"250","type":"RC"},{"code":"64850051501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Amphet/dextr Cap 5mg Er","code_information":[{"code":"CP17744631828510630","type":"CDM"},{"code":"250","type":"RC"},{"code":"52707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Betameth Dip Cre 0.05%","code_information":[{"code":"CP17744631828868107","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Blistex Med Lip Balm","code_information":[{"code":"CP17744631828931419","type":"CDM"},{"code":"250","type":"RC"},{"code":"41388022061","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829014290","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672422201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"But/apap/caf Cap Codeine","code_information":[{"code":"CP17744631829030609","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991007301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Chlorpromaz  Tab 25mg","code_information":[{"code":"CP17744631829218695","type":"CDM"},{"code":"250","type":"RC"},{"code":"78159","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Doxycyc Mono Cap 100mg","code_information":[{"code":"CP17744631829733452","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180065208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Cap 100mg","code_information":[{"code":"CP17744631829746002","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808023302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Cap 100mg","code_information":[{"code":"CP17744631829742102","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808023301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829746222","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135062610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829745122","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806031250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829743875","type":"CDM"},{"code":"250","type":"RC"},{"code":"24658031210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829747684","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135062605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829746642","type":"CDM"},{"code":"250","type":"RC"},{"code":"53489012002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hydrocort Ac Sup 25mg","code_information":[{"code":"CP17744631830102428","type":"CDM"},{"code":"250","type":"RC"},{"code":"39328002924","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Hydromorphon Inj 2mg/ml","code_information":[{"code":"CP17744631830119958","type":"CDM"},{"code":"250","type":"RC"},{"code":"64123","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830216630","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672413304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pramipexole  Tab 0.75 Er","code_information":[{"code":"CP17744631830809598","type":"CDM"},{"code":"250","type":"RC"},{"code":"69680014630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Propranolol  Tab 60mg","code_information":[{"code":"CP17744631830851155","type":"CDM"},{"code":"250","type":"RC"},{"code":"60354","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Scaraway Repari Gel 10g","code_information":[{"code":"CP17744631830997418","type":"CDM"},{"code":"250","type":"RC"},{"code":"7003051172","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"GR"}},{"description":"Topiramate   Tab 100mg","code_information":[{"code":"CP17744631831158534","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Valsart/hctz Tab 320-25mg","code_information":[{"code":"CP17744631831229025","type":"CDM"},{"code":"250","type":"RC"},{"code":"37863","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Valsart/hctz Tab 320-25mg","code_information":[{"code":"CP17744631831227863","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Valsartan    Tab 80mg","code_information":[{"code":"CP17744631831220818","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162083809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Zafirlukast  Tab 20mg","code_information":[{"code":"CP17744631831395002","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722000860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Zolpidem Er  Tab 12.5mg","code_information":[{"code":"CP17744631831402827","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335030888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Zolpidem Er  Tab 12.5mg","code_information":[{"code":"CP17744631831401166","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180078004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Zolpidem Er  Tab 12.5mg","code_information":[{"code":"CP17744631831404603","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991098201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Zolpidem Er  Tab 12.5mg","code_information":[{"code":"CP17744631831403272","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180078001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Zolpidem Er  Tab 12.5mg","code_information":[{"code":"CP17744631831400881","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Zolpidem Er  Tab 6.25mg","code_information":[{"code":"CP17744631831406446","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Zolpidem Er  Tab 6.25mg","code_information":[{"code":"CP17744631831416344","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180077901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Zolpidem Er  Tab 6.25mg","code_information":[{"code":"CP17744631831415147","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991098101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Zolpidem Er  Tab 6.25mg","code_information":[{"code":"CP17744631831412155","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370011710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Zolpidem Er  Tab 6.25mg","code_information":[{"code":"CP17744631831419766","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180077904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Zolpidem Er 12.5mg Tabs","code_information":[{"code":"CP17744631831417647","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335030888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Bumetanide   Tab 2mg","code_information":[{"code":"CP17744631828964251","type":"CDM"},{"code":"250","type":"RC"},{"code":"18501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Comfort Ez   Mis 29gx12mm","code_information":[{"code":"CP17744631829411092","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comfort Ez   Mis 31gx5mm","code_information":[{"code":"CP17744631829416655","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302000199","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comfort Ez   Mis 31gx6mm","code_information":[{"code":"CP17744631829415473","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302000200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comfort Ez   Mis 31gx8mm","code_information":[{"code":"CP17744631829419631","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302000198","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comfort Ez   Mis 32gx4mm","code_information":[{"code":"CP17744631829418207","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014059","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comfort Ez   Mis 32gx5mm","code_information":[{"code":"CP17744631829411453","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014173","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Comfort Ez Pen Ndl 29g 12mm","code_information":[{"code":"CP17744631829416676","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":29,"type":"GR"}},{"description":"Dutasteride  Cap 0.5mg","code_information":[{"code":"CP17744631829768999","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722013130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dutasteride  Cap 0.5mg","code_information":[{"code":"CP17744631829764150","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722013190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Dutasteride 0.5mg Caps","code_information":[{"code":"CP17744631829769675","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380076305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Feverall     Sup 325mg","code_information":[{"code":"CP17744631829943941","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672211602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":325,"type":"ME"}},{"description":"Foley Cath 5cc 2-way 22f","code_information":[{"code":"CP17744631829991832","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999004338","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydralazine  Tab 100mg","code_information":[{"code":"CP17744631830093812","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155000401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Hydroc Iodo  Cre 1-1%","code_information":[{"code":"CP17744631830096176","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367028601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levetiraceta Sol 100mg/ml","code_information":[{"code":"CP17744631830291395","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lorazepam    Inj 2mg/ml","code_information":[{"code":"CP17744631830364535","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Medihoney    Gel Wound","code_information":[{"code":"CP17744631830407388","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Gel Wound","code_information":[{"code":"CP17744631830400368","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Gel Wound","code_information":[{"code":"CP17744631830408557","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Gel Wound","code_information":[{"code":"CP17744631830408977","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney 15ml Gel (40ct)","code_information":[{"code":"CP17744631830403089","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003462","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Medihoney Gel 15ml(10ct) 31505","code_information":[{"code":"CP17744631830402787","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Medihoney Gel 15ml(10ct) 31805","code_information":[{"code":"CP17744631830403972","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003461","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ML"}},{"description":"Memant Titra Pak 5-10mg","code_information":[{"code":"CP17744631830416499","type":"CDM"},{"code":"250","type":"RC"},{"code":"59139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mexiletine   Cap 150mg","code_information":[{"code":"CP17744631830476235","type":"CDM"},{"code":"250","type":"RC"},{"code":"93873","type":"CPT","modifier":"901"}],"standard_charges":[{"setting":"outpatient","modifier_code":["901"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Niacin Er    Tab 750mg","code_information":[{"code":"CP17744631830558669","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651001990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Niacin Er    Tab 750mg","code_information":[{"code":"CP17744631830556766","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Niacin Er    Tab 750mg","code_information":[{"code":"CP17744631830552332","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335061481","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Pen Needle 12mm 29g","code_information":[{"code":"CP17744631830743084","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needle 32g 5mm 3/16","code_information":[{"code":"CP17744631830746854","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014173","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needle Non Safety 12mm 29g","code_information":[{"code":"CP17744631830741654","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles 4mm 32g","code_information":[{"code":"CP17744631830746436","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302014059","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles 5mm 31g","code_information":[{"code":"CP17744631830749700","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302000199","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles 6mm 31g","code_information":[{"code":"CP17744631830749011","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302000200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles 8mm 31g","code_information":[{"code":"CP17744631830745489","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302000198","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rolled Gauze Mis 2\"x2.5yd","code_information":[{"code":"CP17744631830918393","type":"CDM"},{"code":"250","type":"RC"},{"code":"10939030844","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sevelam Carb Tab 800mg","code_information":[{"code":"CP17744631831002001","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862092127","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelam Carb Tab 800mg","code_information":[{"code":"CP17744631831009762","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162005827","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelam Carb Tab 800mg","code_information":[{"code":"CP17744631831003136","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380087267","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelam Carb Tab 800mg","code_information":[{"code":"CP17744631831003585","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111078927","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831017222","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162005827","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer    Tab 800mg","code_information":[{"code":"CP17744631831019317","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111078927","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer 800mg Tabs","code_information":[{"code":"CP17744631831014726","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162005827","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb 800mg Tabs","code_information":[{"code":"CP17744631831017026","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111078927","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb 800mg Tabs","code_information":[{"code":"CP17744631831012228","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162005827","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb 800mg Tabs","code_information":[{"code":"CP17744631831016800","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862092127","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Sevelamer Carb Tab 800mg","code_information":[{"code":"CP17744631831011246","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380087267","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Triazolam    Tab 0.25mg","code_information":[{"code":"CP17744631831186439","type":"CDM"},{"code":"250","type":"RC"},{"code":"54485","type":"CPT","modifier":"929"}],"standard_charges":[{"setting":"outpatient","modifier_code":["929"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Triazolam    Tab 0.25mg","code_information":[{"code":"CP17744631831181476","type":"CDM"},{"code":"250","type":"RC"},{"code":"54485","type":"CPT","modifier":"925"}],"standard_charges":[{"setting":"outpatient","modifier_code":["925"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vibramycin   Cap 100mg","code_information":[{"code":"CP17744631831262876","type":"CDM"},{"code":"250","type":"RC"},{"code":"69095","type":"CPT","modifier":"50"}],"standard_charges":[{"setting":"outpatient","modifier_code":["50"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Vitamin D3   Cap 10000unt","code_information":[{"code":"CP17744631831298662","type":"CDM"},{"code":"250","type":"RC"},{"code":"63044040101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Vitamin D3   Cap 50000unt","code_information":[{"code":"CP17744631831293710","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834002012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Vitamin D3-10,000 Unit-caps","code_information":[{"code":"CP17744631831290347","type":"CDM"},{"code":"250","type":"RC"},{"code":"63044040101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10000,"type":"UN"}},{"description":"Armour Thyro Tab 15mg","code_information":[{"code":"CP17744631828750310","type":"CDM"},{"code":"250","type":"RC"},{"code":"45604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631829009105","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829014651","type":"CDM"},{"code":"250","type":"RC"},{"code":"59126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clarithromyc Tab 250mg","code_information":[{"code":"CP17744631829240322","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862022560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clarithromyc Tab 250mg","code_information":[{"code":"CP17744631829243790","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clarithromyc Tab 500mg","code_information":[{"code":"CP17744631829242854","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862022660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clarithromyc Tab 500mg","code_information":[{"code":"CP17744631829248655","type":"CDM"},{"code":"250","type":"RC"},{"code":"78119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clarithromyc Tab 500mg","code_information":[{"code":"CP17744631829245384","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cyclosporine Cap 100mg Md","code_information":[{"code":"CP17744631829442870","type":"CDM"},{"code":"250","type":"RC"},{"code":"93574","type":"CPT","modifier":"265"}],"standard_charges":[{"setting":"outpatient","modifier_code":["265"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Erythromycin Oin 5mg/gm","code_information":[{"code":"CP17744631829805995","type":"CDM"},{"code":"250","type":"RC"},{"code":"57440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"First-omepra Sus 2mg/ml","code_information":[{"code":"CP17744631829957477","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628007005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Fosinop/hctz Tab 20/12.5","code_information":[{"code":"CP17744631829994612","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097097307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Insu Syringe 31g 1cc","code_information":[{"code":"CP17744631830145338","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013919","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Syrg Mis 0.5/29g","code_information":[{"code":"CP17744631830149870","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013937","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Syrg Mis 0.5/30g","code_information":[{"code":"CP17744631830149667","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013932","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Syrg Mis 0.5/31g","code_information":[{"code":"CP17744631830146527","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Syrg Mis 1ml/29g","code_information":[{"code":"CP17744631830142326","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013938","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Insulin Syrg Mis 1ml/30g","code_information":[{"code":"CP17744631830151733","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013933","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Insulin Syrg Mis 1ml/31g","code_information":[{"code":"CP17744631830157646","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013919","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Insulin Syringe 29g 0.5cc","code_information":[{"code":"CP17744631830153505","type":"CDM"},{"code":"250","type":"RC"},{"code":"98302013937","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iodoform     Pow","code_information":[{"code":"CP17744631830159154","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779250705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Itraconazole Sol 10mg/ml","code_information":[{"code":"CP17744631830177020","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162008774","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ketorolac    Inj 15mg/ml","code_information":[{"code":"CP17744631830193780","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Megestrol    Sus 625mg/5m","code_information":[{"code":"CP17744631830411582","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991031359","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Methazolamid Tab 25mg","code_information":[{"code":"CP17744631830441179","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603016601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Minocycline  Tab 100mg","code_information":[{"code":"CP17744631830487457","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668048750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline  Tab 100mg","code_information":[{"code":"CP17744631830489243","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651033950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline  Tab 100mg","code_information":[{"code":"CP17744631830486726","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884051303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline  Tab 100mg","code_information":[{"code":"CP17744631830486069","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380015601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Moexipril    Tab 15mg","code_information":[{"code":"CP17744631830495260","type":"CDM"},{"code":"250","type":"RC"},{"code":"93515","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mucinex D    Tab 120-1200","code_information":[{"code":"CP17744631830517248","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824004124","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Mucinex D 1200-120mg Tabs","code_information":[{"code":"CP17744631830516888","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824004124","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Nadolol      Tab 80mg","code_information":[{"code":"CP17744631830531328","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097086907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830539418","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291063230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Niva Thyroid Tab 90mg","code_information":[{"code":"CP17744631830571773","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834031301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":90,"type":"ME"}},{"description":"Paroxetin Er Tab 37.5mg","code_information":[{"code":"CP17744631830737813","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180064506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Paroxetin Er Tab 37.5mg","code_information":[{"code":"CP17744631830736104","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241003122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Paroxetin Er Tab 37.5mg","code_information":[{"code":"CP17744631830738756","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175047232","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Profore      Mis","code_information":[{"code":"CP17744631830836172","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Qnapril/hctz Tab 10-12.5","code_information":[{"code":"CP17744631830859282","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862016190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Stahist Ad   Tab 25-60mg","code_information":[{"code":"CP17744631831062262","type":"CDM"},{"code":"250","type":"RC"},{"code":"58407062530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tramadol Er 200mg Tabs","code_information":[{"code":"CP17744631831151740","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335086083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tretinoin    Cre 0.05%","code_information":[{"code":"CP17744631831177715","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714024901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Urea         Cre 40%","code_information":[{"code":"CP17744631831212175","type":"CDM"},{"code":"250","type":"RC"},{"code":"54295030824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Ursodiol     Tab 500mg","code_information":[{"code":"CP17744631831215786","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462047401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Verapamil    Cap 240mg Sr","code_information":[{"code":"CP17744631831262185","type":"CDM"},{"code":"250","type":"RC"},{"code":"59128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Zidovudine   Tab 300mg","code_information":[{"code":"CP17744631831393463","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722050960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Amox/k Clav  Tab 250-125","code_information":[{"code":"CP17744631828504108","type":"CDM"},{"code":"250","type":"RC"},{"code":"78118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"EA"}},{"description":"Amphet/dextr Tab 15mg","code_information":[{"code":"CP17744631828518795","type":"CDM"},{"code":"250","type":"RC"},{"code":"40688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Carteolol    Sol 1% Op","code_information":[{"code":"CP17744631829138672","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314023805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eplerenone   Tab 25mg","code_information":[{"code":"CP17744631829796864","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729029315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Estazolam    Tab 1mg","code_information":[{"code":"CP17744631829814560","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954048010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estazolam    Tab 2mg","code_information":[{"code":"CP17744631829817615","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954048110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Gentamicin   Sol 0.3% Op","code_information":[{"code":"CP17744631830027865","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478028310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Levoxyl      Tab 50mcg","code_information":[{"code":"CP17744631830320581","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793085101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Methylphenid Tab 10mg","code_information":[{"code":"CP17744631830456440","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729047901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Monistat-3 Cream","code_information":[{"code":"CP17744631830509100","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736001518","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Noreth/ethin Chw Fe 1/20","code_information":[{"code":"CP17744631830579467","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700010185","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxymorphone  Tab Hcl 5mg","code_information":[{"code":"CP17744631830725471","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702007006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxymorphone 5mg Tabs","code_information":[{"code":"CP17744631830726487","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702007006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Paroxetine   Tab 40mg","code_information":[{"code":"CP17744631830730634","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Phenazopyrid Tab 100mg","code_information":[{"code":"CP17744631830753696","type":"CDM"},{"code":"250","type":"RC"},{"code":"75826011410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phenytoin    Chw 50mg","code_information":[{"code":"CP17744631830762506","type":"CDM"},{"code":"250","type":"RC"},{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"*Not Availble","code_information":[{"code":"CP17744631828065908","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383017290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Albuterol    Tab 2mg","code_information":[{"code":"CP17744631828381769","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834027301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Albuterol    Tab 2mg","code_information":[{"code":"CP17744631828388821","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980044201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Albuterol    Tab 2mg","code_information":[{"code":"CP17744631828385460","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238134401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Albuterol    Tab 2mg","code_information":[{"code":"CP17744631828386310","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543029010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Albuterol    Tab 4mg","code_information":[{"code":"CP17744631828384652","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238134501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Albuterol    Tab 4mg","code_information":[{"code":"CP17744631828386031","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834027401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Albuterol    Tab 4mg","code_information":[{"code":"CP17744631828385188","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543029110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Alendronate  Tab 10mg","code_information":[{"code":"CP17744631828401662","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714063101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Allevyn Adh  Pad 3\"x3\"","code_information":[{"code":"CP17744631828413472","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Colestipol   Tab 1gm","code_information":[{"code":"CP17744631829409105","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559039512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Curasilk 1\" Cloth Tape","code_information":[{"code":"CP17744631829438591","type":"CDM"},{"code":"250","type":"RC"},{"code":"99999997138","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dexmethylph  Tab 10mg","code_information":[{"code":"CP17744631829576186","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808009301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diphenhydram Inj 50mg/ml","code_information":[{"code":"CP17744631829707087","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dronabinol   Cap 2.5mg","code_information":[{"code":"CP17744631829748880","type":"CDM"},{"code":"250","type":"RC"},{"code":"52714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Felbamate    Tab 400mg","code_information":[{"code":"CP17744631829847108","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559073001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Heparin 5000unit/ml Soln","code_information":[{"code":"CP17744631830075745","type":"CDM"},{"code":"250","type":"RC"},{"code":"64104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"UN"}},{"description":"Heparin Sod  Inj 5000/ml","code_information":[{"code":"CP17744631830080533","type":"CDM"},{"code":"250","type":"RC"},{"code":"64104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Indomethacin Cap 75mg Er","code_information":[{"code":"CP17744631830141570","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162050606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Keralyt      Gel 6%","code_information":[{"code":"CP17744631830187172","type":"CDM"},{"code":"250","type":"RC"},{"code":"11086003060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830211368","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lansoprazole 15mg Caps","code_information":[{"code":"CP17744631830215279","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111039890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lansoprazole 3mg/ml Suspension","code_information":[{"code":"CP17744631830215720","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111039905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Lansoprazole Cap 15mg Dr","code_information":[{"code":"CP17744631830212637","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877027430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lansoprazole Cap 30mg Dr","code_information":[{"code":"CP17744631830215109","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175043041","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Levocarnitin Tab 330mg","code_information":[{"code":"CP17744631830304523","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383017290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Levocarnitine-330mg-tabs","code_information":[{"code":"CP17744631830309107","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383017290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Nitroglycer  Dis 0.6mg/hr","code_information":[{"code":"CP17744631830561625","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Pramipexole  Tab 0.25mg","code_information":[{"code":"CP17744631830809798","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237018190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pregabalin   Cap 150mg","code_information":[{"code":"CP17744631830814412","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Pregabalin   Cap 200mg","code_information":[{"code":"CP17744631830826197","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pregabalin   Cap 225mg","code_information":[{"code":"CP17744631830823892","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332012590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":225,"type":"ME"}},{"description":"Tegaderm Trn Mis Dressing","code_information":[{"code":"CP17744631831109522","type":"CDM"},{"code":"250","type":"RC"},{"code":"51131064114","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tizanidine   Tab 4mg","code_information":[{"code":"CP17744631831130921","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111018010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine Hcl Tab 4mg","code_information":[{"code":"CP17744631831142906","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111018010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Topiramate   Cap 25mg","code_information":[{"code":"CP17744631831155551","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382000514","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bupren/nalox Sub 2-0.5mg","code_information":[{"code":"CP17744631828971091","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175045232","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Bupren/nalox Sub 2-0.5mg","code_information":[{"code":"CP17744631828970042","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756096983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Bupren/nalox Sub 2-0.5mg","code_information":[{"code":"CP17744631828970939","type":"CDM"},{"code":"250","type":"RC"},{"code":"40680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Buprenorphine-nalox 2-0.5mg Tb","code_information":[{"code":"CP17744631828985924","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756096983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Clindamy/ben Gel 1-5%","code_information":[{"code":"CP17744631829250744","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compound W   Liq 17%","code_information":[{"code":"CP17744631829415018","type":"CDM"},{"code":"250","type":"RC"},{"code":"75137059110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":17,"type":"EA"}},{"description":"Dapsone      Tab 25mg","code_information":[{"code":"CP17744631829472248","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954013510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diltiazem    Tab 120mg Er","code_information":[{"code":"CP17744631829698145","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436019506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Ferrex 150   Cap Forte Pl","code_information":[{"code":"CP17744631829865124","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991079890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Ferrex 150   Cap Plus","code_information":[{"code":"CP17744631829867323","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991070390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Florastor    Cap 250mg","code_information":[{"code":"CP17744631829967953","type":"CDM"},{"code":"250","type":"RC"},{"code":"4142000024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Florastor Ki Pak 250mg","code_information":[{"code":"CP17744631829967663","type":"CDM"},{"code":"250","type":"RC"},{"code":"4142000040","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Hydralazine  Tab 100mg","code_information":[{"code":"CP17744631830093482","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111039701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ipratropium  Spr 0.06%","code_information":[{"code":"CP17744631830152200","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208039915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830218736","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Methocarbam  Tab 500mg","code_information":[{"code":"CP17744631830442627","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010075405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Neomycin     Tab 500mg","code_information":[{"code":"CP17744631830542586","type":"CDM"},{"code":"250","type":"RC"},{"code":"93117","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Paroxetine   Tab 25mg Er","code_information":[{"code":"CP17744631830737995","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175047132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Paroxetine   Tab 25mg Er","code_information":[{"code":"CP17744631830737621","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505131703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pull Ups Xxl","code_information":[{"code":"CP17744631830853787","type":"CDM"},{"code":"250","type":"RC"},{"code":"85211000046","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Telmisartan  Tab 20mg","code_information":[{"code":"CP17744631831103965","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831104143","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015772","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831103225","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668015730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Testosterone Gel 1%(25mg)","code_information":[{"code":"CP17744631831117597","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380015102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Thiothixene  Cap 2mg","code_information":[{"code":"CP17744631831125143","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954001510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Torsemide    Tab 100mg","code_information":[{"code":"CP17744631831152219","type":"CDM"},{"code":"250","type":"RC"},{"code":"50111091801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Trueplus     Chw Glucose","code_information":[{"code":"CP17744631831193042","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151161211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Urea         Cre 40%","code_information":[{"code":"CP17744631831212706","type":"CDM"},{"code":"250","type":"RC"},{"code":"44523061707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Align        Cap 10mg","code_information":[{"code":"CP17744631828403870","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000014343","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Align        Cap 4mg","code_information":[{"code":"CP17744631828404424","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000014343","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Barrier Extender 3 Piece","code_information":[{"code":"CP17744631828835736","type":"CDM"},{"code":"250","type":"RC"},{"code":"79402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828999407","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598065630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828996373","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097087612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Desoximetaso Spr 0.25%","code_information":[{"code":"CP17744631829561373","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802080798","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Fenofibrate  Tab 145mg","code_information":[{"code":"CP17744631829858325","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722059690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Fenofibrate  Tab 145mg","code_information":[{"code":"CP17744631829855496","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862076990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Fenofibrate  Tab 145mg","code_information":[{"code":"CP17744631829854802","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304044905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Fenofibrate  Tab 145mg","code_information":[{"code":"CP17744631829850478","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097045805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Fenofibrate  Tab 145mg","code_information":[{"code":"CP17744631829850376","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332036190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Fenofibrate  Tab 145mg","code_information":[{"code":"CP17744631829858221","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304044990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":145,"type":"ME"}},{"description":"Iv Set W/flow Regulator","code_information":[{"code":"CP17744631830174927","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Start Kit","code_information":[{"code":"CP17744631830173506","type":"CDM"},{"code":"250","type":"RC"},{"code":"6124791822","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Start Kit","code_information":[{"code":"CP17744631830170032","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levetiraceta Tab 250mg","code_information":[{"code":"CP17744631830300091","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180011216","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Loratadine-d Tab 5-120mg","code_information":[{"code":"CP17744631830362864","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802012246","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Medihoney    Gel Wound","code_information":[{"code":"CP17744631830406216","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003471","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Gel Wound","code_information":[{"code":"CP17744631830407911","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003472","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney    Pst Wound","code_information":[{"code":"CP17744631830408608","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Medihoney Paste 44ml 31515","code_information":[{"code":"CP17744631830409995","type":"CDM"},{"code":"250","type":"RC"},{"code":"9958003361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":44,"type":"ML"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830532431","type":"CDM"},{"code":"250","type":"RC"},{"code":"40611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830531168","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629104601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830549111","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877039130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830543595","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877039190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 2.5mg","code_information":[{"code":"CP17744631830547269","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877039330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nebivolol    Tab 20mg","code_information":[{"code":"CP17744631830541418","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877039090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nebivolol    Tab 5mg","code_information":[{"code":"CP17744631830548082","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877039230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nebivolol    Tab 5mg","code_information":[{"code":"CP17744631830541159","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877039290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nystatin     Oin 100000","code_information":[{"code":"CP17744631830652759","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100000,"type":"EA"}},{"description":"Nystatin/hydroco 1%/zinc","code_information":[{"code":"CP17744631830656142","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/zinc/hydrocrt/bacitra","code_information":[{"code":"CP17744631830653072","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olm Med/amlo Tab /Hctz","code_information":[{"code":"CP17744631830678922","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664079983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Orajel 3x Mouth Sores","code_information":[{"code":"CP17744631830690538","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310031840","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pot Chloride Sol 20%","code_information":[{"code":"CP17744631830795236","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571035807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Probenecid   Tab 500mg","code_information":[{"code":"CP17744631830830106","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135054101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Quinapril    Tab 20mg","code_information":[{"code":"CP17744631830875992","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084089925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Risperidone   Tab 1mg Odt","code_information":[{"code":"CP17744631830894315","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884031555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Risperidone  Tab 0.5mg Od","code_information":[{"code":"CP17744631830903390","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884031155","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Risperidone  Tab 1mg Odt","code_information":[{"code":"CP17744631830901448","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884031555","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Smz-tmp      Inj 400-80/5","code_information":[{"code":"CP17744631831031122","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457077805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"EA"}},{"description":"Verapamil    Tab 180mg Er","code_information":[{"code":"CP17744631831267324","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Zinc Nyst A+d Hydrocort Dibu","code_information":[{"code":"CP17744631831391964","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amphet/dextr Tab 30mg","code_information":[{"code":"CP17744631828525774","type":"CDM"},{"code":"250","type":"RC"},{"code":"55509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Amphetamine Salts 5 Mg Tab","code_information":[{"code":"CP17744631828521619","type":"CDM"},{"code":"250","type":"RC"},{"code":"40688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Azelaic Acid Gel 15%","code_information":[{"code":"CP17744631828806804","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672138903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Bupren/nalox Sub 2-0.5mg","code_information":[{"code":"CP17744631828978906","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729054910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829031632","type":"CDM"},{"code":"250","type":"RC"},{"code":"42195095510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"But/asa/caff Cap","code_information":[{"code":"CP17744631829045852","type":"CDM"},{"code":"250","type":"RC"},{"code":"78122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Butalb-acetamin-caff 50/300/40","code_information":[{"code":"CP17744631829040651","type":"CDM"},{"code":"250","type":"RC"},{"code":"42195095510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cefuroxime   Tab 250mg","code_information":[{"code":"CP17744631829183509","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877021560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cefuroxime 250mg Tabs","code_information":[{"code":"CP17744631829180585","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877021560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ciprofloxacn Tab 750mg","code_information":[{"code":"CP17744631829246624","type":"CDM"},{"code":"250","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Clindamy/ben Gel 1-5%","code_information":[{"code":"CP17744631829259101","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714098425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clobetasol   Spr 0.05%","code_information":[{"code":"CP17744631829366697","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332042512","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cloraz Dipot Tab 3.75mg","code_information":[{"code":"CP17744631829389761","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Clozapine     Tab 25mg Odt","code_information":[{"code":"CP17744631829398402","type":"CDM"},{"code":"250","type":"RC"},{"code":"37838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clozapine    Tab 25mg Odt","code_information":[{"code":"CP17744631829399604","type":"CDM"},{"code":"250","type":"RC"},{"code":"37838","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Colestid     Gra 5gm","code_information":[{"code":"CP17744631829405856","type":"CDM"},{"code":"250","type":"RC"},{"code":"90260","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Colestid 5gm Granule Sol","code_information":[{"code":"CP17744631829409521","type":"CDM"},{"code":"250","type":"RC"},{"code":"90260","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Conform 6\" Stretch Gauze","code_information":[{"code":"CP17744631829418395","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glipizide Er Tab 5mg","code_information":[{"code":"CP17744631830043109","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ketorolac    Inj 30mg/ml","code_information":[{"code":"CP17744631830194187","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611072225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Klor-con M15 Tab 15meq Er","code_information":[{"code":"CP17744631830190763","type":"CDM"},{"code":"250","type":"RC"},{"code":"24553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Labetalol    Tab 300mg","code_information":[{"code":"CP17744631830203661","type":"CDM"},{"code":"250","type":"RC"},{"code":"71247013001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830213066","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382000905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830215573","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672413204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830216678","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668004905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830216869","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668004960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine  Tab 200mg","code_information":[{"code":"CP17744631830210964","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Lamotrigine 200mg Tabs","code_information":[{"code":"CP17744631830210920","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097015212","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Levoflox/d5w Inj 250/50ml","code_information":[{"code":"CP17744631830308833","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Levofloxacin 250mg/50ml Dex","code_information":[{"code":"CP17744631830303540","type":"CDM"},{"code":"250","type":"RC"},{"code":"14397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Methylpred   Tab 4mg","code_information":[{"code":"CP17744631830457269","type":"CDM"},{"code":"250","type":"RC"},{"code":"60345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Miconazole 7 Sup 100mg","code_information":[{"code":"CP17744631830482797","type":"CDM"},{"code":"250","type":"RC"},{"code":"47217","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830508487","type":"CDM"},{"code":"250","type":"RC"},{"code":"78155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830509972","type":"CDM"},{"code":"250","type":"RC"},{"code":"78155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830509298","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722072830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Montelukast  Tab 10mg","code_information":[{"code":"CP17744631830500201","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300022019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Montelukast  Tab 10mg","code_information":[{"code":"CP17744631830500915","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729011917","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Montelukast  Tab 10mg","code_information":[{"code":"CP17744631830505191","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300022010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Montelukast 10mg Tabs","code_information":[{"code":"CP17744631830507652","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300022010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Montelukast 10mg Tabs","code_information":[{"code":"CP17744631830507879","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300022019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Montelukast 10mg Tabs","code_information":[{"code":"CP17744631830504332","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729011917","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830549409","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559027790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830544909","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559027730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 20mg","code_information":[{"code":"CP17744631830548998","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559027830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nebivolol    Tab 20mg","code_information":[{"code":"CP17744631830549683","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nebivolol    Tab 5mg","code_information":[{"code":"CP17744631830546770","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559027690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nebivolol    Tab 5mg","code_information":[{"code":"CP17744631830543044","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722058630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olmesa Medox Tab 5mg","code_information":[{"code":"CP17744631830677689","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462043630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxycodone    Tab 15mg","code_information":[{"code":"CP17744631830713339","type":"CDM"},{"code":"250","type":"RC"},{"code":"40685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxymorphone  Tab Hcl 5mg","code_information":[{"code":"CP17744631830724159","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107010301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pimozide     Tab 1mg","code_information":[{"code":"CP17744631830778277","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884034701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Pimozide 1mg Tabs","code_information":[{"code":"CP17744631830777111","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884034701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Prevail Undr Mis Xlarge","code_information":[{"code":"CP17744631830823776","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891050031","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Qnapril/hctz Tab 20-12.5","code_information":[{"code":"CP17744631830868466","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862016290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Sertraline   Tab 25mg","code_information":[{"code":"CP17744631831008526","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862001105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Triazolam    Tab 0.25mg","code_information":[{"code":"CP17744631831185109","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762371809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Tri-linyah   Tab","code_information":[{"code":"CP17744631831196118","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714036304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Blink Tears  Dro 0.25% Op","code_information":[{"code":"CP17744631828937098","type":"CDM"},{"code":"250","type":"RC"},{"code":"29943000410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ciprofloxacin 750mg Tabs","code_information":[{"code":"CP17744631829233600","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862007850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Ciprofloxacn Tab 750mg","code_information":[{"code":"CP17744631829249065","type":"CDM"},{"code":"250","type":"RC"},{"code":"16252051605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Ciprofloxacn Tab 750mg","code_information":[{"code":"CP17744631829241080","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651087350","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Ciprofloxacn Tab 750mg","code_information":[{"code":"CP17744631829240510","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862007850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Clotrimazole Sol 1%","code_information":[{"code":"CP17744631829394199","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954003620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Daysee       Tab","code_information":[{"code":"CP17744631829546024","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180084613","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclofenac   Tab 100mg Er","code_information":[{"code":"CP17744631829594947","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799095301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Differin     Gel 0.1%","code_information":[{"code":"CP17744631829608809","type":"CDM"},{"code":"250","type":"RC"},{"code":"29949","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dilantin-125 Sus 125/5ml","code_information":[{"code":"CP17744631829608692","type":"CDM"},{"code":"250","type":"RC"},{"code":"58151011535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829740327","type":"CDM"},{"code":"250","type":"RC"},{"code":"62584069321","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Felbamate    Sus 600/5ml","code_information":[{"code":"CP17744631829844052","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954005120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Felbamate    Tab 400mg","code_information":[{"code":"CP17744631829845255","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578005601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Fluconazole  Tab 50mg","code_information":[{"code":"CP17744631829963008","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714069401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fluconazole  Tab 50mg","code_information":[{"code":"CP17744631829966671","type":"CDM"},{"code":"250","type":"RC"},{"code":"67405060103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fluconazole  Tab 50mg","code_information":[{"code":"CP17744631829966484","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462010130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fluphenazine Tab 1mg","code_information":[{"code":"CP17744631829988421","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714067201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Gastrografin 66-10 Solution","code_information":[{"code":"CP17744631830020290","type":"CDM"},{"code":"250","type":"RC"},{"code":"27004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":66,"type":"EA"}},{"description":"Gastrografin Sol 66-10%","code_information":[{"code":"CP17744631830029760","type":"CDM"},{"code":"250","type":"RC"},{"code":"27004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":66,"type":"EA"}},{"description":"Gentamicin   Oin 0.1%","code_information":[{"code":"CP17744631830023666","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802004611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Labetalol    Tab 300mg","code_information":[{"code":"CP17744631830205337","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377006213","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Olmesa Medox Tab 5mg","code_information":[{"code":"CP17744631830675806","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olmesa Medox Tab 5mg","code_information":[{"code":"CP17744631830670602","type":"CDM"},{"code":"250","type":"RC"},{"code":"52724","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Olmesa Medox Tab 5mg","code_information":[{"code":"CP17744631830676541","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729032010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxycodone    Tab 15mg","code_information":[{"code":"CP17744631830711018","type":"CDM"},{"code":"250","type":"RC"},{"code":"40685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Paper Surgical Tape 2\"","code_information":[{"code":"CP17744631830732182","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784035532","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paroxetin Er Tab 12.5mg","code_information":[{"code":"CP17744631830736308","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241002922","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Paroxetin Er Tab 12.5mg","code_information":[{"code":"CP17744631830730129","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175047032","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Paroxetin Er Tab 12.5mg","code_information":[{"code":"CP17744631830735865","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505131603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Paroxetine   Tab 30mg","code_information":[{"code":"CP17744631830733118","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714018303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Piroxicam    Cap 10mg","code_information":[{"code":"CP17744631830783921","type":"CDM"},{"code":"250","type":"RC"},{"code":"93075","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Risperidone  Sol 1mg/ml","code_information":[{"code":"CP17744631830903672","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808000201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Risperidone  Sol 1mg/ml","code_information":[{"code":"CP17744631830906714","type":"CDM"},{"code":"250","type":"RC"},{"code":"54006","type":"CPT","modifier":"344"}],"standard_charges":[{"setting":"outpatient","modifier_code":["344"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sertraline   Tab 100mg","code_information":[{"code":"CP17744631831007334","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714061304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Telmisartan  Tab 20mg","code_information":[{"code":"CP17744631831100338","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877048230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Trazodone    Tab 150mg","code_information":[{"code":"CP17744631831168510","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668033201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Tretinoin    Cre 0.05%","code_information":[{"code":"CP17744631831176011","type":"CDM"},{"code":"250","type":"RC"},{"code":"57422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Zilactin-b   Gel 10%","code_information":[{"code":"CP17744631831399423","type":"CDM"},{"code":"250","type":"RC"},{"code":"50486055032","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Alclometason Oin 0.05%","code_information":[{"code":"CP17744631828390367","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462029917","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Apap/codeine 300-30mg Tabs","code_information":[{"code":"CP17744631828722751","type":"CDM"},{"code":"250","type":"RC"},{"code":"40604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Apap/codeine Tab 300-30mg","code_information":[{"code":"CP17744631828728447","type":"CDM"},{"code":"250","type":"RC"},{"code":"40604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Aug Betamet  Oin 0.05%","code_information":[{"code":"CP17744631828793820","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bd Syr 50ml  Mis Luer-lok","code_information":[{"code":"CP17744631828845632","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290309653","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Beta Diprop  Oin 0.05%","code_information":[{"code":"CP17744631828867258","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Betameth Dp Aug .05% Oint","code_information":[{"code":"CP17744631828871833","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Budesonide   Sus 0.5mg/2","code_information":[{"code":"CP17744631828966784","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097031987","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829240991","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714065202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciprofloxacn Tab 750mg","code_information":[{"code":"CP17744631829241972","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714065301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Doxycycl Hyc Cap 100mg","code_information":[{"code":"CP17744631829747838","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Cap 100mg","code_information":[{"code":"CP17744631829745272","type":"CDM"},{"code":"250","type":"RC"},{"code":"14398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycl Hyc Tab 100mg","code_information":[{"code":"CP17744631829741343","type":"CDM"},{"code":"250","type":"RC"},{"code":"14321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enalapril    Tab 20mg","code_information":[{"code":"CP17744631829771024","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Ergocalcifer Dro 8000/ml","code_information":[{"code":"CP17744631829794738","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367028302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ergocalcifer Sol 8000/ml","code_information":[{"code":"CP17744631829798989","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543023460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8000,"type":"EA"}},{"description":"Ergocalciferol 8000iu/ml Sol","code_information":[{"code":"CP17744631829796313","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543023460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8000,"type":"F2"}},{"description":"Flecainide   Tab 150mg","code_information":[{"code":"CP17744631829953265","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746064301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fluocin Acet Cre 0.025%","code_information":[{"code":"CP17744631829969673","type":"CDM"},{"code":"250","type":"RC"},{"code":"71307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Haloperidol  Tab 10mg","code_information":[{"code":"CP17744631830061268","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292058801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Infusion Set, Sm Vein 23g","code_information":[{"code":"CP17744631830142420","type":"CDM"},{"code":"250","type":"RC"},{"code":"50182","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":23,"type":"GR"}},{"description":"Iv Small Infusion Set","code_information":[{"code":"CP17744631830177667","type":"CDM"},{"code":"250","type":"RC"},{"code":"50182","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Onetouch     Tes Verio","code_information":[{"code":"CP17744631830693323","type":"CDM"},{"code":"250","type":"RC"},{"code":"53885027210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Risperidone   Tab 0.25 Odt","code_information":[{"code":"CP17744631830899873","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884021255","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Risperidone  Tab 0.25 Odt","code_information":[{"code":"CP17744631830904102","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884021255","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Telfa Island Pad 4\"x5\"","code_information":[{"code":"CP17744631831103795","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080754000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Telmisartan  Tab 20mg","code_information":[{"code":"CP17744631831101075","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462019930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Telmisartan  Tab 20mg","code_information":[{"code":"CP17744631831107685","type":"CDM"},{"code":"250","type":"RC"},{"code":"37829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Telmisartan  Tab 20mg","code_information":[{"code":"CP17744631831109340","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571022630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831101539","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862086803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831105738","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462020030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831104095","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571022730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831103410","type":"CDM"},{"code":"250","type":"RC"},{"code":"37829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831103692","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462020013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831107127","type":"CDM"},{"code":"250","type":"RC"},{"code":"37829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831100284","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462020130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831108606","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462020113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Urea         Cre 40%","code_information":[{"code":"CP17744631831214837","type":"CDM"},{"code":"250","type":"RC"},{"code":"54295030815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Urinary Leg Bag With Anti","code_information":[{"code":"CP17744631831210236","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784042822","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venelex      Oin","code_information":[{"code":"CP17744631831255378","type":"CDM"},{"code":"250","type":"RC"},{"code":"58980078011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alka Seltz +Sev Cld/flu D","code_information":[{"code":"CP17744631828400290","type":"CDM"},{"code":"250","type":"RC"},{"code":"1650055942","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alka-selt +  Pak Sv Cl/fl","code_information":[{"code":"CP17744631828413206","type":"CDM"},{"code":"250","type":"RC"},{"code":"16500055942","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alprazolam   Tab 0.25 Odt","code_information":[{"code":"CP17744631828449477","type":"CDM"},{"code":"250","type":"RC"},{"code":"22840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Alprazolam Odt 0.25mg Tabs","code_information":[{"code":"CP17744631828450748","type":"CDM"},{"code":"250","type":"RC"},{"code":"22840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amlod/valsar Tab 5-160mg","code_information":[{"code":"CP17744631828480060","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/valsar Tab 5-160mg","code_information":[{"code":"CP17744631828484699","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/valsar Tab 5-160mg","code_information":[{"code":"CP17744631828485739","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155084403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/valsar Tab 5-160mg","code_information":[{"code":"CP17744631828486773","type":"CDM"},{"code":"250","type":"RC"},{"code":"37817","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlodipine-valsartan 5-160 Mg","code_information":[{"code":"CP17744631828498783","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332020590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amoxapine    Tab 50mg","code_information":[{"code":"CP17744631828502417","type":"CDM"},{"code":"250","type":"RC"},{"code":"59157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cane Tips Mis 1/2","code_information":[{"code":"CP17744631829106909","type":"CDM"},{"code":"250","type":"RC"},{"code":"54756085012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cryselle-28  Tab 28 Tabs","code_information":[{"code":"CP17744631829436567","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":28,"type":"EA"}},{"description":"Cyclosporine Cap 100mg Md","code_information":[{"code":"CP17744631829445595","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505463203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Donepezil    Tab 10mg Odt","code_information":[{"code":"CP17744631829727125","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342003007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Haloperidol  Tab 20mg","code_information":[{"code":"CP17744631830061419","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382008101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Heparin Sod  Inj 1000/ml","code_information":[{"code":"CP17744631830074310","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288040202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"EA"}},{"description":"Ivizia Dry Eye Drops 10m","code_information":[{"code":"CP17744631830174811","type":"CDM"},{"code":"250","type":"RC"},{"code":"9484185003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Jelcaine Str Gel 2%","code_information":[{"code":"CP17744631830183666","type":"CDM"},{"code":"250","type":"RC"},{"code":"71351002530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lidocaine Pa Pad 4%","code_information":[{"code":"CP17744631830331860","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000036601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Liothyronine Tab 25mcg","code_information":[{"code":"CP17744631830349312","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862032101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Neuriva      Cap","code_information":[{"code":"CP17744631830554614","type":"CDM"},{"code":"250","type":"RC"},{"code":"47865099547","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Retin-a      Cre 0.025%","code_information":[{"code":"CP17744631830899889","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Retin-a 0.025% Cream","code_information":[{"code":"CP17744631830891542","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Retin-a 0.05% Cream","code_information":[{"code":"CP17744631830894075","type":"CDM"},{"code":"250","type":"RC"},{"code":"18751","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Risperidone   Tab 1mg Odt","code_information":[{"code":"CP17744631830891452","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746002022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Risperidone  Tab 1mg Odt","code_information":[{"code":"CP17744631830905444","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746002022","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ropinirole   Tab 4mg Er","code_information":[{"code":"CP17744631830912554","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111066190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ropinirole   Tab 4mg Er","code_information":[{"code":"CP17744631830913548","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111066130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Telmisartan  Tab 20mg","code_information":[{"code":"CP17744631831109729","type":"CDM"},{"code":"250","type":"RC"},{"code":"72606050603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Telmisartan  Tab 40mg","code_information":[{"code":"CP17744631831108142","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382047278","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831106731","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382047378","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831101900","type":"CDM"},{"code":"250","type":"RC"},{"code":"72606050803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Terbutaline  Tab 2.5mg","code_information":[{"code":"CP17744631831118961","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559072101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Thiothixene  Cap 2mg","code_information":[{"code":"CP17744631831120017","type":"CDM"},{"code":"250","type":"RC"},{"code":"37820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Topiramate   Tab 100mg","code_information":[{"code":"CP17744631831156988","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462010910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Trazodone    Tab 300mg","code_information":[{"code":"CP17744631831165406","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107008201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Trazodone    Tab 300mg","code_information":[{"code":"CP17744631831161396","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729030201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Trazodone    Tab 300mg","code_information":[{"code":"CP17744631831167553","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382080801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Align        Cap 4mg","code_information":[{"code":"CP17744631828408428","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000029417","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Amlod/benazp Cap 5-10mg","code_information":[{"code":"CP17744631828488088","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180075601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Capsaicin Heat Patch 0.025%","code_information":[{"code":"CP17744631829107026","type":"CDM"},{"code":"250","type":"RC"},{"code":"65923012301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Captopril    Tab 50mg","code_information":[{"code":"CP17744631829103696","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829244032","type":"CDM"},{"code":"250","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Citracal Cal Tab +D Slow","code_information":[{"code":"CP17744631829241399","type":"CDM"},{"code":"250","type":"RC"},{"code":"16500054099","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Depend Adj   Mis Large","code_information":[{"code":"CP17744631829557441","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000019379","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Droxia       Cap 400mg","code_information":[{"code":"CP17744631829753457","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269040460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Ery/benzoyl  Gel 3-5%","code_information":[{"code":"CP17744631829801315","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682090146","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Hydrophilic Cath 14fr.16\"","code_information":[{"code":"CP17744631830116867","type":"CDM"},{"code":"250","type":"RC"},{"code":"11357","type":"CPT","modifier":"27"}],"standard_charges":[{"setting":"outpatient","modifier_code":["27"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketorolac    Inj 30mg/ml","code_information":[{"code":"CP17744631830190888","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ketorolac 30mg/ml Soln","code_information":[{"code":"CP17744631830192987","type":"CDM"},{"code":"250","type":"RC"},{"code":"33800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830217119","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Loratadine D Tab 5-120mg","code_information":[{"code":"CP17744631830368197","type":"CDM"},{"code":"250","type":"RC"},{"code":"70677003601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Loratadine-d Tab 5-120mg","code_information":[{"code":"CP17744631830360228","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802012260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Metoprl/hctz Tab 50-25mg","code_information":[{"code":"CP17744631830465143","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332011531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Mirtazapine  Tab 15mg","code_information":[{"code":"CP17744631830493677","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mirtazapine  Tab 15mg","code_information":[{"code":"CP17744631830495607","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079008620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mirtazapine 15mg Tabs","code_information":[{"code":"CP17744631830498000","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237000805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Nadolol      Tab 80mg","code_information":[{"code":"CP17744631830539985","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155073201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Prednisone   Pak 10mg","code_information":[{"code":"CP17744631830814227","type":"CDM"},{"code":"250","type":"RC"},{"code":"59154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prevagen","code_information":[{"code":"CP17744631830825325","type":"CDM"},{"code":"250","type":"RC"},{"code":"94047000106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tretinoin    Cre 0.025%","code_information":[{"code":"CP17744631831171312","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672140709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Triazolam 0.25mg Tabs","code_information":[{"code":"CP17744631831189968","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762371803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Urea         Cre 40%","code_information":[{"code":"CP17744631831212846","type":"CDM"},{"code":"250","type":"RC"},{"code":"44523061701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"EA"}},{"description":"Valsa/hctz 320/12.5mg Tabs","code_information":[{"code":"CP17744631831220992","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332008290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Valsart/hctz Tab 320-12.5","code_information":[{"code":"CP17744631831224374","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"EA"}},{"description":"Valsartan/hydro 320-12.5m-tab","code_information":[{"code":"CP17744631831220770","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Alprazolam   Tab 0.5mg Od","code_information":[{"code":"CP17744631828449231","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011174","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alprazolam   Tab 3mg Er","code_information":[{"code":"CP17744631828457436","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862045760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Alprazolam Odt 0.5mg Tbdp","code_information":[{"code":"CP17744631828455448","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011174","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Asperflex    Pad Original","code_information":[{"code":"CP17744631828769274","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399446105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aug Betamet  Gel 0.05%","code_information":[{"code":"CP17744631828794020","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Beta Diprop  Gel 0.05%","code_information":[{"code":"CP17744631828865654","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Captopril    Tab 12.5mg","code_information":[{"code":"CP17744631829107670","type":"CDM"},{"code":"250","type":"RC"},{"code":"14311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Cartia Xt    Cap 240/24hr","code_information":[{"code":"CP17744631829130144","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037059905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"EA"}},{"description":"Cholestyram  Pow 4gm Lite","code_information":[{"code":"CP17744631829223003","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884046665","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829249121","type":"CDM"},{"code":"250","type":"RC"},{"code":"16252051501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Desonide     Cre 0.05%","code_information":[{"code":"CP17744631829564429","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Cre 0.05%","code_information":[{"code":"CP17744631829567689","type":"CDM"},{"code":"250","type":"RC"},{"code":"47208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Cre 0.05%","code_information":[{"code":"CP17744631829564694","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Cre 0.05%","code_information":[{"code":"CP17744631829561521","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672128003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Cre 0.05%","code_information":[{"code":"CP17744631829565515","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672128001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Cre 0.05%","code_information":[{"code":"CP17744631829564456","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578008601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Cre 0.05%","code_information":[{"code":"CP17744631829563151","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Oin 0.05%","code_information":[{"code":"CP17744631829561499","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922000407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dicloxacill  Cap 500mg","code_information":[{"code":"CP17744631829599834","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651056601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Dicloxacill  Cap 500mg","code_information":[{"code":"CP17744631829593815","type":"CDM"},{"code":"250","type":"RC"},{"code":"93312","type":"CPT","modifier":"501"}],"standard_charges":[{"setting":"outpatient","modifier_code":["501"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Diltiazem Er Cap 240mg","code_information":[{"code":"CP17744631829698900","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037059905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Doxepin Hcl  Cap 100mg","code_information":[{"code":"CP17744631829732232","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651017701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluoxetine 40mg Caps","code_information":[{"code":"CP17744631829978828","type":"CDM"},{"code":"250","type":"RC"},{"code":"78128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluticasone  Spr 50mcg","code_information":[{"code":"CP17744631829988132","type":"CDM"},{"code":"250","type":"RC"},{"code":"60432026415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Guaifenesin  Liq 100/5ml","code_information":[{"code":"CP17744631830069982","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657050916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Halobetasol  Cre 0.05%","code_information":[{"code":"CP17744631830066423","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Halobetasol  Cre 0.05%","code_information":[{"code":"CP17744631830060137","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Naphcon-a    Sol Op","code_information":[{"code":"CP17744631830538090","type":"CDM"},{"code":"250","type":"RC"},{"code":"65008","type":"CPT","modifier":"542"}],"standard_charges":[{"setting":"outpatient","modifier_code":["542"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830648321","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830646252","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Oin","code_information":[{"code":"CP17744631830648828","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922003105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Orsythia     Tab","code_information":[{"code":"CP17744631830694996","type":"CDM"},{"code":"250","type":"RC"},{"code":"25420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Paroxetine   Tab 10mg","code_information":[{"code":"CP17744631830736815","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547034750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Paroxetine 10mg Tabs","code_information":[{"code":"CP17744631830732874","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547034750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pioglita/met Tab 15-500mg","code_information":[{"code":"CP17744631830770707","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342017609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglita/met Tab 15-850mg","code_information":[{"code":"CP17744631830778835","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237021860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglita/met Tab 15-850mg","code_information":[{"code":"CP17744631830773833","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342017709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pioglitazone/metformin 15-500m","code_information":[{"code":"CP17744631830777397","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668028060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Progesterone Cap 200mg","code_information":[{"code":"CP17744631830832981","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Terconazole  Cre 0.8%","code_information":[{"code":"CP17744631831116138","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130200","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"EA"}},{"description":"Theophylline Tab 600mg Er","code_information":[{"code":"CP17744631831129999","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858070201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Tobra Sulf 200mg/ns 0.9% 100ml","code_information":[{"code":"CP17744631831142174","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Tobra Sulf 300mg/ns 0.9% 100ml","code_information":[{"code":"CP17744631831140091","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Tobra Sulf 320mg/ns 0.9% 100ml","code_information":[{"code":"CP17744631831142369","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":320,"type":"ME"}},{"description":"Tobra Sulf 360mg/ns 0.9% 100ml","code_information":[{"code":"CP17744631831141736","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":360,"type":"ME"}},{"description":"Tobramycin   Inj 40mg/ml","code_information":[{"code":"CP17744631831149518","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tobramycin 400mg/100ml Ns","code_information":[{"code":"CP17744631831148097","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Tpn Electrol Inj","code_information":[{"code":"CP17744631831154552","type":"CDM"},{"code":"250","type":"RC"},{"code":"40957","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tramadol Hcl 100mg Er Tab","code_information":[{"code":"CP17744631831157196","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180069706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Tramadol Hcl Tab 100mg Er","code_information":[{"code":"CP17744631831155158","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180069706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ursodiol     Tab 250mg","code_information":[{"code":"CP17744631831219311","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380091806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Zincox 20%/nyst+traim Cre","code_information":[{"code":"CP17744631831403057","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Zincox 20%-nyst/triam Cream","code_information":[{"code":"CP17744631831404465","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Albumin Hum  Inj 25%","code_information":[{"code":"CP17744631828371917","type":"CDM"},{"code":"250","type":"RC"},{"code":"68982064301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Alprazolam    Tab 0.25 Odt","code_information":[{"code":"CP17744631828445605","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Alprazolam   Tab 0.25 Odt","code_information":[{"code":"CP17744631828440125","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Alprazolam   Tab 0.5mg Er","code_information":[{"code":"CP17744631828444792","type":"CDM"},{"code":"250","type":"RC"},{"code":"22830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alprazolam Odt 0.25mg Tabs","code_information":[{"code":"CP17744631828450834","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884011074","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amphet/dextr Tab 15mg","code_information":[{"code":"CP17744631828512957","type":"CDM"},{"code":"250","type":"RC"},{"code":"55507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Bupropion    Tab 300mg Xl","code_information":[{"code":"CP17744631828980951","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806041605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropion Xl 300mg Tabs","code_information":[{"code":"CP17744631828990830","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828992047","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806041605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631829006620","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Buspirone    Tab 5mg","code_information":[{"code":"CP17744631829008148","type":"CDM"},{"code":"250","type":"RC"},{"code":"93005","type":"CPT","modifier":"305"}],"standard_charges":[{"setting":"outpatient","modifier_code":["305"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Citalopram   Tab 40mg","code_information":[{"code":"CP17744631829246954","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668001105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Citalopram 40mg Tabs","code_information":[{"code":"CP17744631829249997","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668001105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Clobazam     Tab 20mg","code_information":[{"code":"CP17744631829263782","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672420301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Desmopressin 0.1mg Tabs","code_information":[{"code":"CP17744631829562672","type":"CDM"},{"code":"250","type":"RC"},{"code":"59124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Desmopressin Tab 0.1mg","code_information":[{"code":"CP17744631829566479","type":"CDM"},{"code":"250","type":"RC"},{"code":"69918010101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Desmopressin Tab 0.1mg","code_information":[{"code":"CP17744631829563855","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155048901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Desonide     Oin 0.05%","code_information":[{"code":"CP17744631829562304","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714082802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexameth Pho Inj 4mg/ml","code_information":[{"code":"CP17744631829577012","type":"CDM"},{"code":"250","type":"RC"},{"code":"64161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Dexamethason Con 1mg/ml","code_information":[{"code":"CP17744631829574078","type":"CDM"},{"code":"250","type":"RC"},{"code":"54317","type":"CPT","modifier":"644"}],"standard_charges":[{"setting":"outpatient","modifier_code":["644"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Diltiazem    Cap 60mg Er","code_information":[{"code":"CP17744631829693332","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979018101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Felbamate    Tab 600mg","code_information":[{"code":"CP17744631829844998","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578005701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Fluticasone  Spr 50mcg","code_information":[{"code":"CP17744631829984313","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383070016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fluticasone 50mcg/act Spray","code_information":[{"code":"CP17744631829985536","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383070016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Fortify Prob Cap Womens","code_information":[{"code":"CP17744631829998158","type":"CDM"},{"code":"250","type":"RC"},{"code":"33674011581","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Icosapent    Cap 0.5gm","code_information":[{"code":"CP17744631830139255","type":"CDM"},{"code":"250","type":"RC"},{"code":"48001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Klor-con M15 Tab 15meq Er","code_information":[{"code":"CP17744631830199616","type":"CDM"},{"code":"250","type":"RC"},{"code":"24553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830210348","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Levoxyl      Tab 25mcg","code_information":[{"code":"CP17744631830328166","type":"CDM"},{"code":"250","type":"RC"},{"code":"60793085001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mirtazapine  Tab 7.5mg","code_information":[{"code":"CP17744631830499678","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107000130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Nexium 24hr  Cap 20mg","code_information":[{"code":"CP17744631830550995","type":"CDM"},{"code":"250","type":"RC"},{"code":"57324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nexium 24hr  Tab 20mg","code_information":[{"code":"CP17744631830550611","type":"CDM"},{"code":"250","type":"RC"},{"code":"57324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Phenobarb    Tab 30mg","code_information":[{"code":"CP17744631830769194","type":"CDM"},{"code":"250","type":"RC"},{"code":"13517069201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Precisedose  Mis 0.5ml","code_information":[{"code":"CP17744631830817234","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779815503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Prednisone   Pak 10mg","code_information":[{"code":"CP17744631830816839","type":"CDM"},{"code":"250","type":"RC"},{"code":"60353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prilosec Otc Tab 20mg","code_information":[{"code":"CP17744631830836392","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000035905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Prilosec Otc Tab 20mg","code_information":[{"code":"CP17744631830835482","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000045502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Propranolol  Tab 60mg","code_information":[{"code":"CP17744631830853976","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292053601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Telmisa/hctz Tab 80-12.5","code_information":[{"code":"CP17744631831107448","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547044203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Zovia 1/35   Tab","code_information":[{"code":"CP17744631831419445","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907008762","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zovia 1/35   Tab","code_information":[{"code":"CP17744631831416724","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862089406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alclometason Cre 0.05%","code_information":[{"code":"CP17744631828391650","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Amoxicillin  Tab 875mg","code_information":[{"code":"CP17744631828516380","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237002901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Bactrim800-160/500mld5w","code_information":[{"code":"CP17744631828830866","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069036110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Briefs Bariatric Xxl","code_information":[{"code":"CP17744631828943333","type":"CDM"},{"code":"250","type":"RC"},{"code":"86679037739","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Budesonide   Sus 0.25mg/2","code_information":[{"code":"CP17744631828954358","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097031887","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bumetanide   Inj 1mg/4ml","code_information":[{"code":"CP17744631828964014","type":"CDM"},{"code":"250","type":"RC"},{"code":"72205010107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Bupropion    Tab 150mg Xl","code_information":[{"code":"CP17744631828980210","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropion Hcl Xl 150mg Tab(24h","code_information":[{"code":"CP17744631828998029","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828993283","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729044310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828998106","type":"CDM"},{"code":"250","type":"RC"},{"code":"59133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cetirizine   Sol 1mg/ml","code_information":[{"code":"CP17744631829209509","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135005741","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829246956","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135030905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cloraz Dipot Tab 3.75mg","code_information":[{"code":"CP17744631829385648","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672404201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Dexameth Pho Inj 4mg/ml","code_information":[{"code":"CP17744631829575739","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Erythromycin Gel 2%","code_information":[{"code":"CP17744631829809999","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565003330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830216823","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382000810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830218168","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830214859","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746024705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamotrigine  Tab 150mg","code_information":[{"code":"CP17744631830213161","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668004805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lamotrigine Tab 150mg","code_information":[{"code":"CP17744631830216784","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Lasix        Tab 20mg","code_information":[{"code":"CP17744631830222884","type":"CDM"},{"code":"250","type":"RC"},{"code":"30698006701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Lasix 20mg Tabs","code_information":[{"code":"CP17744631830227146","type":"CDM"},{"code":"250","type":"RC"},{"code":"30698006701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Methylphenid Tab 5mg","code_information":[{"code":"CP17744631830454863","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664022888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Misoprostol  Tab 200mcg","code_information":[{"code":"CP17744631830498012","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762500801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Myambutol    Tab 400mg","code_information":[{"code":"CP17744631830521920","type":"CDM"},{"code":"250","type":"RC"},{"code":"68850001201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Neomycin     Tab 500mg","code_information":[{"code":"CP17744631830542999","type":"CDM"},{"code":"250","type":"RC"},{"code":"39822031005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Niacin       Tab 500mg Er","code_information":[{"code":"CP17744631830559241","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342018710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Niacin Er    Tab 500mg","code_information":[{"code":"CP17744631830559922","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162032109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Niacin Er    Tab 500mg Er","code_information":[{"code":"CP17744631830554361","type":"CDM"},{"code":"250","type":"RC"},{"code":"62175032046","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Oxycodone    Cap 5mg","code_information":[{"code":"CP17744631830712889","type":"CDM"},{"code":"250","type":"RC"},{"code":"68308014501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Poise        Pad Maximum","code_information":[{"code":"CP17744631830785671","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000019283","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Progesterone Cap 100mg","code_information":[{"code":"CP17744631830833208","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Propranolol  Tab 60mg","code_information":[{"code":"CP17744631830852500","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238208001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Sm Enema     Ene","code_information":[{"code":"CP17744631831037548","type":"CDM"},{"code":"250","type":"RC"},{"code":"49348018620","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sulfa/trim 400mg/100ml D5w","code_information":[{"code":"CP17744631831078855","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069036110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Tranex Acid  Tab 650mg","code_information":[{"code":"CP17744631831169546","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559026530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Valsartan    Tab 160mg","code_information":[{"code":"CP17744631831225067","type":"CDM"},{"code":"250","type":"RC"},{"code":"37858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Valsartan    Tab 160mg","code_information":[{"code":"CP17744631831226731","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291085890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Valsartan 160mg Tabs","code_information":[{"code":"CP17744631831224478","type":"CDM"},{"code":"250","type":"RC"},{"code":"37858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Aztreonam 500mg / 50ml Ns","code_information":[{"code":"CP17744631828811281","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828838322","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651039505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828837935","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817032110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828833045","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714007204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828839936","type":"CDM"},{"code":"250","type":"RC"},{"code":"60324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828835589","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300034401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen 20mg Tabs","code_information":[{"code":"CP17744631828838928","type":"CDM"},{"code":"250","type":"RC"},{"code":"60324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Bisacodyl    Sup 10mg","code_information":[{"code":"CP17744631828920819","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237032721","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Buspirone    Tab 7.5mg","code_information":[{"code":"CP17744631829012340","type":"CDM"},{"code":"250","type":"RC"},{"code":"37811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Buspirone 7.5mg Tabs","code_information":[{"code":"CP17744631829019660","type":"CDM"},{"code":"250","type":"RC"},{"code":"37811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Carb/levo100 Tab /Entacap","code_information":[{"code":"CP17744631829114051","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571069101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Cefdinir     Cap 300mg","code_information":[{"code":"CP17744631829156040","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862017760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cefdinir     Cap 300mg","code_information":[{"code":"CP17744631829156111","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714039102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cefdinir     Cap 300mg","code_information":[{"code":"CP17744631829156541","type":"CDM"},{"code":"250","type":"RC"},{"code":"78121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cefdinir 300mg Caps","code_information":[{"code":"CP17744631829151459","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714039102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829224545","type":"CDM"},{"code":"250","type":"RC"},{"code":"24505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Ciprofloxacn Sol 0.3% Op","code_information":[{"code":"CP17744631829230774","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Citalopram   Tab 20mg","code_information":[{"code":"CP17744631829240495","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668001005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Citalopram 20mg Tabs","code_information":[{"code":"CP17744631829240121","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668001005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Clarithromyc Sus 125/5ml","code_information":[{"code":"CP17744631829246058","type":"CDM"},{"code":"250","type":"RC"},{"code":"78160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Econazole    Cre 1%","code_information":[{"code":"CP17744631829768432","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672130308","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Econazole    Cre 1%","code_information":[{"code":"CP17744631829761217","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565002285","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Econazole 1% Cream","code_information":[{"code":"CP17744631829769183","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565002285","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fish Oil     Cap 1000mg","code_information":[{"code":"CP17744631829955931","type":"CDM"},{"code":"250","type":"RC"},{"code":"40985022872","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Fish Oil 1000mg Caps","code_information":[{"code":"CP17744631829952174","type":"CDM"},{"code":"250","type":"RC"},{"code":"40985022872","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Fluocinonide Gel 0.05%","code_information":[{"code":"CP17744631829977950","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluvoxamine  Tab 50mg","code_information":[{"code":"CP17744631829983502","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fluvoxamine 50mg Tabs","code_information":[{"code":"CP17744631829991762","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505016501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Hydroxocobal Inj 1000mcg","code_information":[{"code":"CP17744631830110354","type":"CDM"},{"code":"250","type":"RC"},{"code":"59128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Jergens Shea Butter","code_information":[{"code":"CP17744631830182084","type":"CDM"},{"code":"250","type":"RC"},{"code":"19100011012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Junel Fe     Tab 1/20","code_information":[{"code":"CP17744631830182002","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830211018","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672413101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamotrigine Tab 100mg","code_information":[{"code":"CP17744631830212118","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672413101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Larin Fe     Tab 1.5/30","code_information":[{"code":"CP17744631830221944","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Larin Fe     Tab 1/20","code_information":[{"code":"CP17744631830222207","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040604","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lorazepam    Con 2mg/ml","code_information":[{"code":"CP17744631830361828","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383070530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Lovastatin   Tab 40mg","code_information":[{"code":"CP17744631830370885","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442014301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Methylp Ss 1g/250ml Ns","code_information":[{"code":"CP17744631830444303","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Mucinex Cold Cap /Flu","code_information":[{"code":"CP17744631830518157","type":"CDM"},{"code":"250","type":"RC"},{"code":"72854013616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mucinex Dm   Tab 60-1200","code_information":[{"code":"CP17744631830512392","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824007236","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Mucinex Dm 60-1200mg Tabs","code_information":[{"code":"CP17744631830512013","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824007236","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Paroxetin Er Tab 37.5mg","code_information":[{"code":"CP17744631830732579","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858070703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Peg 3350     Pow","code_information":[{"code":"CP17744631830747193","type":"CDM"},{"code":"250","type":"RC"},{"code":"90469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Primidone    Tab 250mg","code_information":[{"code":"CP17744631830838689","type":"CDM"},{"code":"250","type":"RC"},{"code":"59153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Refresh      Sol Optive","code_information":[{"code":"CP17744631830880708","type":"CDM"},{"code":"250","type":"RC"},{"code":"23430","type":"CPT","modifier":"720"}],"standard_charges":[{"setting":"outpatient","modifier_code":["720"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Spirono/hctz Tab 25/25","code_information":[{"code":"CP17744631831053943","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762501401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Steril Water Inj","code_information":[{"code":"CP17744631831061440","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sterile      Inj Water","code_information":[{"code":"CP17744631831062137","type":"CDM"},{"code":"250","type":"RC"},{"code":"40948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Surgical Tapes Cloth 1x10","code_information":[{"code":"CP17744631831089443","type":"CDM"},{"code":"250","type":"RC"},{"code":"16471","type":"CPT","modifier":"10"}],"standard_charges":[{"setting":"outpatient","modifier_code":["10"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tizanidine   Cap 6mg","code_information":[{"code":"CP17744631831133305","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746067234","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Tizanidine   Cap 6mg","code_information":[{"code":"CP17744631831130387","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505265007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Tizanidine   Cap 6mg","code_information":[{"code":"CP17744631831135325","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888000315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Tizanidine   Cap 6mg","code_information":[{"code":"CP17744631831133303","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877061215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Tizanidine   Cap 6mg","code_information":[{"code":"CP17744631831134365","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834020915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Valsartan    Tab 160mg","code_information":[{"code":"CP17744631831227290","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547036909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Valsartan    Tab 40mg","code_information":[{"code":"CP17744631831222627","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162083703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Xeroform Ocl Pad 1x8\"","code_information":[{"code":"CP17744631831381211","type":"CDM"},{"code":"250","type":"RC"},{"code":"8884433301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xeroform Pet Pad 1\"x8\"","code_information":[{"code":"CP17744631831385489","type":"CDM"},{"code":"250","type":"RC"},{"code":"8884433301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xerofrm Gauz Mis 1\"x8\"","code_information":[{"code":"CP17744631831382086","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080433301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amox/clav 875/125 Mg Tablet","code_information":[{"code":"CP17744631828493791","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714047801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Amox/clav 875-125mg Tabs","code_information":[{"code":"CP17744631828494309","type":"CDM"},{"code":"250","type":"RC"},{"code":"66685100100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Amox/clav 875-125mg Tabs","code_information":[{"code":"CP17744631828499901","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Amox/clav 875-125mg Tabs","code_information":[{"code":"CP17744631828495403","type":"CDM"},{"code":"250","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828504828","type":"CDM"},{"code":"250","type":"RC"},{"code":"93227","type":"CPT","modifier":"534"}],"standard_charges":[{"setting":"outpatient","modifier_code":["534"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828506314","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571016242","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828500611","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714047801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828502654","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571016201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828503047","type":"CDM"},{"code":"250","type":"RC"},{"code":"78118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Bupropion    Tab 100mg Sr","code_information":[{"code":"CP17744631828985229","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228017405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cefuroxime   Tab 250mg","code_information":[{"code":"CP17744631829185521","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cefuroxime 250mg Tabs","code_information":[{"code":"CP17744631829185814","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Diclo/misopr Tab 50-0.2mg","code_information":[{"code":"CP17744631829591192","type":"CDM"},{"code":"250","type":"RC"},{"code":"59103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Droxia       Cap 200mg","code_information":[{"code":"CP17744631829755997","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269040260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Droxia       Cap 200mg","code_information":[{"code":"CP17744631829753658","type":"CDM"},{"code":"250","type":"RC"},{"code":"36335","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Droxia       Cap 300mg","code_information":[{"code":"CP17744631829750483","type":"CDM"},{"code":"250","type":"RC"},{"code":"36336","type":"CPT","modifier":"17"}],"standard_charges":[{"setting":"outpatient","modifier_code":["17"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Ds Duragel Bunion Cushion","code_information":[{"code":"CP17744631829750161","type":"CDM"},{"code":"250","type":"RC"},{"code":"88885300115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluoxetine   Cap 10mg","code_information":[{"code":"CP17744631829979802","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluoxetine   Cap 40mg","code_information":[{"code":"CP17744631829977592","type":"CDM"},{"code":"250","type":"RC"},{"code":"93719","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine   Cap 40mg","code_information":[{"code":"CP17744631829977936","type":"CDM"},{"code":"250","type":"RC"},{"code":"78128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine   Cap 40mg","code_information":[{"code":"CP17744631829979724","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine   Cap 40mg","code_information":[{"code":"CP17744631829979362","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine   Cap 40mg","code_information":[{"code":"CP17744631829976360","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine 40mg Caps","code_information":[{"code":"CP17744631829972071","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862019401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine 40mg Caps","code_information":[{"code":"CP17744631829978283","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332002431","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluoxetine Hcl Cap 10mg","code_information":[{"code":"CP17744631829970958","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluoxetine Hcl Cap 40mg","code_information":[{"code":"CP17744631829971725","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714072202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluticasone  Spr 50mcg","code_information":[{"code":"CP17744631829985676","type":"CDM"},{"code":"250","type":"RC"},{"code":"53611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Gentamicin   Inj 40mg/ml","code_information":[{"code":"CP17744631830025278","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gentamicin 132mg/250ml Sterile","code_information":[{"code":"CP17744631830030456","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":132,"type":"ME"}},{"description":"Gentamicin 60 Mg/ 100 Ml El-j","code_information":[{"code":"CP17744631830036387","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Gentamicin 80mg/100ml Ns","code_information":[{"code":"CP17744631830037926","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150040225","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Glycopyrrol  Inj 0.2mg/ml","code_information":[{"code":"CP17744631830053921","type":"CDM"},{"code":"250","type":"RC"},{"code":"66794020242","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Halobetasol  Cre 0.05%","code_information":[{"code":"CP17744631830064805","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Halobetasol  Oin 0.05%","code_information":[{"code":"CP17744631830063640","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802013132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Halobetasol 0.05% Oint","code_information":[{"code":"CP17744631830062686","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802013132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydromorphon Tab 2mg","code_information":[{"code":"CP17744631830114728","type":"CDM"},{"code":"250","type":"RC"},{"code":"40632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Iferex 150   Cap","code_information":[{"code":"CP17744631830137320","type":"CDM"},{"code":"250","type":"RC"},{"code":"63044020361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Methylpred   Tab 16mg","code_information":[{"code":"CP17744631830453908","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382091818","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Metoprol Suc Tab 200mg Er","code_information":[{"code":"CP17744631830466345","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603014501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Metoprol Suc Tab 200mg Er","code_information":[{"code":"CP17744631830464504","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714085501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Metoprolol Er 200mg Tabs","code_information":[{"code":"CP17744631830472736","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714085501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Metronidazol Gel 1%","code_information":[{"code":"CP17744631830479296","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672421509","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Monistat 3   Kit Combo Pk","code_information":[{"code":"CP17744631830501138","type":"CDM"},{"code":"250","type":"RC"},{"code":"63736044300","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Morphine Sul Tab 15mg","code_information":[{"code":"CP17744631830509075","type":"CDM"},{"code":"250","type":"RC"},{"code":"54023","type":"CPT","modifier":"524"}],"standard_charges":[{"setting":"outpatient","modifier_code":["524"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830531939","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335032688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Np Thyroid   Tab 15mg","code_information":[{"code":"CP17744631830640340","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192032701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Poly-iron    Cap 150mg","code_information":[{"code":"CP17744631830780161","type":"CDM"},{"code":"250","type":"RC"},{"code":"63044020361","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Prednisone   Pak 10mg","code_information":[{"code":"CP17744631830813101","type":"CDM"},{"code":"250","type":"RC"},{"code":"59154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Prednisone   Tab 50mg","code_information":[{"code":"CP17744631830817056","type":"CDM"},{"code":"250","type":"RC"},{"code":"54001","type":"CPT","modifier":"920"}],"standard_charges":[{"setting":"outpatient","modifier_code":["920"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Propranolol  Tab 40mg","code_information":[{"code":"CP17744631830843477","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238207901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Risperidone  Sol 1mg/ml","code_information":[{"code":"CP17744631830905378","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162067384","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Selenium Sul Sha 2.3%","code_information":[{"code":"CP17744631830999104","type":"CDM"},{"code":"250","type":"RC"},{"code":"52191035006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Theratears   Sol Extra","code_information":[{"code":"CP17744631831125844","type":"CDM"},{"code":"250","type":"RC"},{"code":"58790000715","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Topiramate   Tab 50mg","code_information":[{"code":"CP17744631831154517","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097012303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Topiramate   Tab 50mg","code_information":[{"code":"CP17744631831159904","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335071013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Topiramate   Tab 50mg","code_information":[{"code":"CP17744631831150652","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571070606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Topiramate   Tab 50mg","code_information":[{"code":"CP17744631831159207","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382013905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Topiramate 50mg Tabs","code_information":[{"code":"CP17744631831150883","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382013905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Venlafaxine  Cap 150mg Er","code_information":[{"code":"CP17744631831250651","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722000490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Cap 150mg Er","code_information":[{"code":"CP17744631831258571","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668002090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Cap 150mg Er","code_information":[{"code":"CP17744631831257123","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Cap 150mg Er","code_information":[{"code":"CP17744631831255190","type":"CDM"},{"code":"250","type":"RC"},{"code":"93738","type":"CPT","modifier":"656"}],"standard_charges":[{"setting":"outpatient","modifier_code":["656"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine  Cap 150mg Er","code_information":[{"code":"CP17744631831252483","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Venlafaxine Er 150mg Caps","code_information":[{"code":"CP17744631831264761","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382003610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Xeroform 5\"x9\" Dressing","code_information":[{"code":"CP17744631831380901","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784305424","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xeroform 5\"x9\" Pads","code_information":[{"code":"CP17744631831389416","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784305424","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acetazolamid Cap 500mg Er","code_information":[{"code":"CP17744631828250700","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710159101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Amphet/dextr Tab 10mg","code_information":[{"code":"CP17744631828510001","type":"CDM"},{"code":"250","type":"RC"},{"code":"55509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amphet/dextr Tab 5mg","code_information":[{"code":"CP17744631828521097","type":"CDM"},{"code":"250","type":"RC"},{"code":"55509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bd Eclipse   Mis 25gx5/8\"","code_information":[{"code":"CP17744631828841779","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305829","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bupren/nalox Film 2-0.5mg","code_information":[{"code":"CP17744631828975821","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Bupren/nalox Mis 2-0.5mg","code_information":[{"code":"CP17744631828975877","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781035503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Clemastine   Tab 2.68mg","code_information":[{"code":"CP17744631829256218","type":"CDM"},{"code":"250","type":"RC"},{"code":"93030","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":268,"type":"ME"}},{"description":"Clonazepam   Tab 1mg","code_information":[{"code":"CP17744631829373961","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547040711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonazepam 1mg Tabs","code_information":[{"code":"CP17744631829374006","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547040711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Desloratadin Tab 5mg","code_information":[{"code":"CP17744631829560289","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Desloratadin Tab 5mg","code_information":[{"code":"CP17744631829566287","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543010710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Desloratadin Tab 5mg","code_information":[{"code":"CP17744631829566852","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Desonide     Lot 0.05%","code_information":[{"code":"CP17744631829568744","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462051339","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Lot 0.05%","code_information":[{"code":"CP17744631829564854","type":"CDM"},{"code":"250","type":"RC"},{"code":"47208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dicyclomine  Tab 20mg","code_information":[{"code":"CP17744631829600112","type":"CDM"},{"code":"250","type":"RC"},{"code":"14312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Erythrom Eth Sus 200/5ml","code_information":[{"code":"CP17744631829804166","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559063001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fluocin Acet Cre 0.01%","code_information":[{"code":"CP17744631829963927","type":"CDM"},{"code":"250","type":"RC"},{"code":"71302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glycopyrrol  Tab 1mg","code_information":[{"code":"CP17744631830058522","type":"CDM"},{"code":"250","type":"RC"},{"code":"90467","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Haloper Lac  Inj 5mg/ml","code_information":[{"code":"CP17744631830065458","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Haloperidol 5mg/ml Soln","code_information":[{"code":"CP17744631830072455","type":"CDM"},{"code":"250","type":"RC"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hc Valerate  Oin 0.2%","code_information":[{"code":"CP17744631830079524","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462083665","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Ketorolac    Inj 15mg/ml","code_information":[{"code":"CP17744631830194529","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332059925","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lacosamide150/50ml Kit","code_information":[{"code":"CP17744631830206938","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598008758","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Lido/prilocn Cre 2.5-2.5%","code_information":[{"code":"CP17744631830326758","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629960401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Lidocaine    Sol 4%","code_information":[{"code":"CP17744631830337758","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954051810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Mask Surgical 3ply","code_information":[{"code":"CP17744631830405612","type":"CDM"},{"code":"250","type":"RC"},{"code":"26491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Montelukast  Chw 4mg","code_information":[{"code":"CP17744631830501232","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668007930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830508161","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668008090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830505083","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300022219","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830502045","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237021330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Montelukast  Chw 5mg","code_information":[{"code":"CP17744631830509946","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237021390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Naproxen Sod Tab 275mg","code_information":[{"code":"CP17744631830543077","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746019301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":275,"type":"ME"}},{"description":"Nizatidine   Cap 300mg","code_information":[{"code":"CP17744631830578857","type":"CDM"},{"code":"250","type":"RC"},{"code":"59131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Oxycodone    Tab 20mg","code_information":[{"code":"CP17744631830718794","type":"CDM"},{"code":"250","type":"RC"},{"code":"40685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pantoprazole Tab 20mg","code_information":[{"code":"CP17744631830733378","type":"CDM"},{"code":"250","type":"RC"},{"code":"72865022990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pantoprazole Tab 20mg Dr","code_information":[{"code":"CP17744631830730910","type":"CDM"},{"code":"250","type":"RC"},{"code":"72865022990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pindolol     Tab 10mg","code_information":[{"code":"CP17744631830777719","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385013201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Proben/colch Tab 500-0.5","code_information":[{"code":"CP17744631830836844","type":"CDM"},{"code":"250","type":"RC"},{"code":"59153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Ropinirole   Tab 0.5mg","code_information":[{"code":"CP17744631830910406","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462025401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Ropinirole Hcl Tab 0.5mg","code_information":[{"code":"CP17744631830913280","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462025401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Theophylline Tab 600mg Er","code_information":[{"code":"CP17744631831121362","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462035601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Tolterodine  Tab 2mg","code_information":[{"code":"CP17744631831154565","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300024016","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Topiramate   Tab 50mg","code_information":[{"code":"CP17744631831155847","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Tramadol     Sol 5mg/ml","code_information":[{"code":"CP17744631831157012","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817061516","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tri-sprintec Tab","code_information":[{"code":"CP17744631831199710","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ubiquinol    Cap 100mg","code_information":[{"code":"CP17744631831200420","type":"CDM"},{"code":"250","type":"RC"},{"code":"31604002850","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Valproic Acd Cap 250mg","code_information":[{"code":"CP17744631831229688","type":"CDM"},{"code":"250","type":"RC"},{"code":"59140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Valsartan    Tab 160mg","code_information":[{"code":"CP17744631831228742","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862057290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Vitamin D3   Cap 1.25mg","code_information":[{"code":"CP17744631831299103","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681017401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Acetazolamid Cap 500mg Er","code_information":[{"code":"CP17744631828254805","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742023301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Amox/clav 875-125mg Tabs","code_information":[{"code":"CP17744631828491695","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714047802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"ME"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828505733","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862050301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Amox/k Clav  Tab 875-125","code_information":[{"code":"CP17744631828503584","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714047802","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":875,"type":"EA"}},{"description":"Bacitr Zinc  Oin 500/gm","code_information":[{"code":"CP17744631828828087","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Carb/levo    Tab 25-100mg","code_information":[{"code":"CP17744631829107133","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687066101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo    Tab 25-250mg","code_information":[{"code":"CP17744631829103327","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo 25-250mg Odt","code_information":[{"code":"CP17744631829113619","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo Odt 25/250mg","code_information":[{"code":"CP17744631829115087","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018888","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ciprofloxacin 500mg Tabs","code_information":[{"code":"CP17744631829234472","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714065204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829243443","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714065204","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829249067","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657067601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829242974","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651086705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829240890","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571041250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Claritin     Cap 10mg","code_information":[{"code":"CP17744631829247811","type":"CDM"},{"code":"250","type":"RC"},{"code":"41100080798","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cromolyn Sod Neb 20mg/2ml","code_information":[{"code":"CP17744631829436730","type":"CDM"},{"code":"250","type":"RC"},{"code":"69543045660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Divalproex   Tab 250mg Er","code_information":[{"code":"CP17744631829711814","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714048402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Divalproex Er 250mg Tabs","code_information":[{"code":"CP17744631829711053","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714048402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Doxycyc Mono Tab 100mg","code_information":[{"code":"CP17744631829737628","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710112307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycyc Mono Tab 100mg","code_information":[{"code":"CP17744631829748325","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155013525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Enpresse-28  Tab","code_information":[{"code":"CP17744631829781054","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":28,"type":"EA"}},{"description":"Florastor    Cap 250mg","code_information":[{"code":"CP17744631829965631","type":"CDM"},{"code":"250","type":"RC"},{"code":"4142000007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830215687","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714019501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830214218","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830214461","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Levonest     Tab","code_information":[{"code":"CP17744631830319966","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714034004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Methenam Hip Tab 1gm","code_information":[{"code":"CP17744631830441850","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315021001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Metolazone   Tab 5mg","code_information":[{"code":"CP17744631830458699","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292056401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Risperidone  Tab 0.5mg Od","code_information":[{"code":"CP17744631830905102","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884031191","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Risperidone  Tab 0.5mg Od","code_information":[{"code":"CP17744631830908469","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746001032","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Risperidone Odt 0.5mg Tabs","code_information":[{"code":"CP17744631830904154","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746001032","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Risperidone Odt 0.5mg Tbdp","code_information":[{"code":"CP17744631830908154","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884031191","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831132064","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478028811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Valsartan    Tab 160mg","code_information":[{"code":"CP17744631831226695","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746036290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Zyrtec-d     Tab 5-120mg","code_information":[{"code":"CP17744631831414245","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580072824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zyrtec-d 5-120mg Tabs","code_information":[{"code":"CP17744631831416247","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580072824","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Allergy Relf Tab 5-120mg","code_information":[{"code":"CP17744631828419904","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660094024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alprazolam   Tab 2mg Xr","code_information":[{"code":"CP17744631828456746","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762006601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Amlod/benazp Cap 10-40mg","code_information":[{"code":"CP17744631828483174","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180047301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/benazp Cap 10-40mg","code_information":[{"code":"CP17744631828485933","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862058705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/benazp Cap 10-40mg","code_information":[{"code":"CP17744631828489644","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111058601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/benazp Cap 10-40mg","code_information":[{"code":"CP17744631828489524","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862058701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Apri         Tab","code_information":[{"code":"CP17744631828730805","type":"CDM"},{"code":"250","type":"RC"},{"code":"55590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Aug Betamet  Lot 0.05%","code_information":[{"code":"CP17744631828791817","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672134004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Azelastine   Spr 0.1%","code_information":[{"code":"CP17744631828808140","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291009430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Spr 0.1%","code_information":[{"code":"CP17744631828808515","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162067684","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Beta Diprop  Lot 0.05%","code_information":[{"code":"CP17744631828866823","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672134004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bupropion Er 300mg Tabs","code_information":[{"code":"CP17744631828995083","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828990426","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Carb/levo 75 Tab /Entacap","code_information":[{"code":"CP17744631829115889","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571069001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Ciprofloxacn Tab 500mg","code_information":[{"code":"CP17744631829246179","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657067650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Depend Lg Underwear Woman","code_information":[{"code":"CP17744631829555834","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000012537","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diclo/misopr Tab 75-0.2mg","code_information":[{"code":"CP17744631829598220","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571013460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Dicyclomine  Cap 10mg","code_information":[{"code":"CP17744631829598232","type":"CDM"},{"code":"250","type":"RC"},{"code":"59107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Estra/noreth Tab 1-0.5mg","code_information":[{"code":"CP17744631829816448","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991047428","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Estra/noreth Tab 1-0.5mg","code_information":[{"code":"CP17744631829818944","type":"CDM"},{"code":"250","type":"RC"},{"code":"37872","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Florastor    Cap 250mg","code_information":[{"code":"CP17744631829965154","type":"CDM"},{"code":"250","type":"RC"},{"code":"4142000032","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Hydrocolloid Dressing","code_information":[{"code":"CP17744631830101505","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247919294","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroquinone Cre 4%","code_information":[{"code":"CP17744631830115511","type":"CDM"},{"code":"250","type":"RC"},{"code":"72056006001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Meloxicam    Tab 15mg","code_information":[{"code":"CP17744631830417668","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097015915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Meloxicam    Tab 15mg","code_information":[{"code":"CP17744631830415776","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382005105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Meloxicam    Tab 15mg","code_information":[{"code":"CP17744631830418766","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300012510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Meloxicam 15mg Tabs","code_information":[{"code":"CP17744631830418010","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097015915","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Metaxalone   Tab 800mg","code_information":[{"code":"CP17744631830432351","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980047201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Metoprl/hctz Tab 50-25mg","code_information":[{"code":"CP17744631830466048","type":"CDM"},{"code":"250","type":"RC"},{"code":"37804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Metoprol Tar Tab 75mg","code_information":[{"code":"CP17744631830464256","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817035910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Metoprolol   Tab 75mg","code_information":[{"code":"CP17744631830466792","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817035910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Metronidazol Cre 0.75%","code_information":[{"code":"CP17744631830470007","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578012908","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Metronidazol Pow","code_information":[{"code":"CP17744631830472486","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779014605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830482678","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505132501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830481071","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382073901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830481517","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700015901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830486051","type":"CDM"},{"code":"250","type":"RC"},{"code":"37819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine    Tab 10mg","code_information":[{"code":"CP17744631830486707","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980043501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine    Tab 5mg","code_information":[{"code":"CP17744631830483369","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Midodrine    Tab 5mg","code_information":[{"code":"CP17744631830481294","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505132101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Midodrine 10mg Tabs","code_information":[{"code":"CP17744631830486607","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505132501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Midodrine 5mg Tabs","code_information":[{"code":"CP17744631830489667","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505132101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Misoprostol  Tab 100mcg","code_information":[{"code":"CP17744631830490877","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135074560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Morphine Sul Tab 30mg","code_information":[{"code":"CP17744631830505971","type":"CDM"},{"code":"250","type":"RC"},{"code":"54023","type":"CPT","modifier":"625"}],"standard_charges":[{"setting":"outpatient","modifier_code":["625"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Nitro-time   Cap 2.5mg Cr","code_information":[{"code":"CP17744631830574186","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483022106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Oxcarbazepin Tab 600mg","code_information":[{"code":"CP17744631830704821","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756018588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxcarbazepin Tab 600mg","code_information":[{"code":"CP17744631830705319","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756018518","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxcarbazepin Tab 600mg","code_information":[{"code":"CP17744631830708527","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756018513","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Risperidone  Sol 1mg/ml","code_information":[{"code":"CP17744631830902504","type":"CDM"},{"code":"250","type":"RC"},{"code":"50458059601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Sertraline   Con 20mg/ml","code_information":[{"code":"CP17744631831000732","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762006701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Sterile Nitrile Glove P/f","code_information":[{"code":"CP17744631831061040","type":"CDM"},{"code":"250","type":"RC"},{"code":"85380000341","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831130188","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980051401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Valsart/hctz Tab 160-25mg","code_information":[{"code":"CP17744631831227899","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332008190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Valsart/hctz Tab 160-25mg","code_information":[{"code":"CP17744631831226660","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Valsartan    Tab 80mg","code_information":[{"code":"CP17744631831222406","type":"CDM"},{"code":"250","type":"RC"},{"code":"37858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Valsartan    Tab 80mg","code_information":[{"code":"CP17744631831229959","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291085790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Alcohol Prep Pad Med 70%","code_information":[{"code":"CP17744631828396505","type":"CDM"},{"code":"250","type":"RC"},{"code":"42423027102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amlod/olmesa Tab 10-20mg","code_information":[{"code":"CP17744631828486383","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664077399","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Asperflex    Pad Hot Pain","code_information":[{"code":"CP17744631828765052","type":"CDM"},{"code":"250","type":"RC"},{"code":"71399443906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Beelith      Tab","code_information":[{"code":"CP17744631828853297","type":"CDM"},{"code":"250","type":"RC"},{"code":"48611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Benzonatate  Cap 200mg","code_information":[{"code":"CP17744631828864251","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806071501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Benzonatate  Cap 200mg","code_information":[{"code":"CP17744631828861589","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722095801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Bromocriptin Tab 2.5mg","code_information":[{"code":"CP17744631828953290","type":"CDM"},{"code":"250","type":"RC"},{"code":"57401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bupropion    Tab 150mg Xl","code_information":[{"code":"CP17744631828984293","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571086203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropion Xl 150mg Tabs","code_information":[{"code":"CP17744631828993694","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180031902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropion Xl 300mg Tabs","code_information":[{"code":"CP17744631828994211","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370010250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828998857","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304072330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828991509","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304072305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828993230","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382035316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828999866","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370010103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828998763","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979010107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828990227","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571086209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828995017","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571086203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828993263","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180031909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828990049","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304072390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828990241","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180031902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828990385","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382035305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828997266","type":"CDM"},{"code":"250","type":"RC"},{"code":"77771014590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828993187","type":"CDM"},{"code":"250","type":"RC"},{"code":"10370010250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Bupropn Hcl  Tab 300mg Xl","code_information":[{"code":"CP17744631828993670","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180032006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"But/apap/caf 50-300-40mg Caps","code_information":[{"code":"CP17744631829018736","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010004401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829010504","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010004401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Candesa/hctz Tab 32-12.5","code_information":[{"code":"CP17744631829095385","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559066190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":32,"type":"EA"}},{"description":"Cimetidine   Tab 400mg","code_information":[{"code":"CP17744631829235167","type":"CDM"},{"code":"250","type":"RC"},{"code":"37803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Clobetasol   Lot 0.05%","code_information":[{"code":"CP17744631829263040","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672135004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clozapine    Tab 100mg","code_information":[{"code":"CP17744631829397652","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079092220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cold/hot Back 5% Patch","code_information":[{"code":"CP17744631829403205","type":"CDM"},{"code":"250","type":"RC"},{"code":"50804002408","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Commode Spec Collector","code_information":[{"code":"CP17744631829419339","type":"CDM"},{"code":"250","type":"RC"},{"code":"48796","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cyclobenzapr Tab 7.5mg","code_information":[{"code":"CP17744631829430708","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603031101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cyclobenzapr Tab 7.5mg","code_information":[{"code":"CP17744631829435631","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888001301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cyclobenzapr Tab 7.5mg","code_information":[{"code":"CP17744631829446467","type":"CDM"},{"code":"250","type":"RC"},{"code":"93342","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Cyclobenzapr Tab 7.5mg","code_information":[{"code":"CP17744631829440338","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817033110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Desmopressin Tab 0.2mg","code_information":[{"code":"CP17744631829561101","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Furosemide   Inj 40mg/4ml","code_information":[{"code":"CP17744631830009727","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Furosemide   Inj 40mg/4ml","code_information":[{"code":"CP17744631830003897","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729050143","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Furosemide 10mg/ml Inj","code_information":[{"code":"CP17744631830008235","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Furosemide 40 Mg In 50 Ml Ns","code_information":[{"code":"CP17744631830013920","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Furosemide 40 Mg/50 Ml Ns","code_information":[{"code":"CP17744631830013531","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Glipizide Er Tab 10mg","code_information":[{"code":"CP17744631830044398","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714089601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Glyb/metform Tab 1.25-250","code_information":[{"code":"CP17744631830055635","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155023301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Haloperidol  Tab 5mg","code_information":[{"code":"CP17744631830075032","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292058601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hearing Aid Batt 675","code_information":[{"code":"CP17744631830078881","type":"CDM"},{"code":"250","type":"RC"},{"code":"3980004364","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydromorphon Tab 8mg","code_information":[{"code":"CP17744631830116771","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858030301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Isoniazid    Tab 300mg","code_information":[{"code":"CP17744631830165614","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687055301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"L-methylfola Tab 15mg","code_information":[{"code":"CP17744631830353233","type":"CDM"},{"code":"250","type":"RC"},{"code":"76439035890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Loratadine-d Tab 10-240mg","code_information":[{"code":"CP17744631830361726","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Metformin    Tab 850mg","code_information":[{"code":"CP17744631830436337","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385094811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Metformin    Tab 850mg","code_information":[{"code":"CP17744631830430125","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010006410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Metformin Hcl Tab 850mg","code_information":[{"code":"CP17744631830443993","type":"CDM"},{"code":"250","type":"RC"},{"code":"42385094811","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":850,"type":"ME"}},{"description":"Methocarbam  Tab 750mg","code_information":[{"code":"CP17744631830447283","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010077005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Montelukast  Tab 10mg","code_information":[{"code":"CP17744631830506676","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342010215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Montelukast  Tab 10mg","code_information":[{"code":"CP17744631830501836","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342010207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Morphine Sul 15mg Er Tab","code_information":[{"code":"CP17744631830505926","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858080101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Morphine Sul Tab 15mg Er","code_information":[{"code":"CP17744631830504505","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858080101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Ondansetron  Sol 4mg/5ml","code_information":[{"code":"CP17744631830688107","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162069179","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ondansetron  Sol 4mg/5ml","code_information":[{"code":"CP17744631830684325","type":"CDM"},{"code":"250","type":"RC"},{"code":"54838055550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Ondansetron  Sol 4mg/5ml","code_information":[{"code":"CP17744631830682615","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714067102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Osteo Bi-flex Ease Advanc","code_information":[{"code":"CP17744631830695527","type":"CDM"},{"code":"250","type":"RC"},{"code":"3076855388","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxcarbazepin Tab 600mg","code_information":[{"code":"CP17744631830708084","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxcarbazepin Tab 600mg","code_information":[{"code":"CP17744631830700272","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991029401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Oxcarbazepine 600mg Tabs","code_information":[{"code":"CP17744631830701086","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Pravastatin  Tab 40mg","code_information":[{"code":"CP17744631830805180","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111023105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin  Tab 40mg","code_information":[{"code":"CP17744631830806226","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729001017","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin  Tab 40mg","code_information":[{"code":"CP17744631830809753","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505017009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin  Tab 40mg","code_information":[{"code":"CP17744631830808517","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687019001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin  Tab 40mg","code_information":[{"code":"CP17744631830806654","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714056001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin  Tab 40mg","code_information":[{"code":"CP17744631830805985","type":"CDM"},{"code":"250","type":"RC"},{"code":"93720","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin  Tab 40mg","code_information":[{"code":"CP17744631830806913","type":"CDM"},{"code":"250","type":"RC"},{"code":"93720","type":"CPT","modifier":"298"}],"standard_charges":[{"setting":"outpatient","modifier_code":["298"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin  Tab 80mg","code_information":[{"code":"CP17744631830801954","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462019805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pravastatin  Tab 80mg","code_information":[{"code":"CP17744631830807070","type":"CDM"},{"code":"250","type":"RC"},{"code":"48072","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pravastatin  Tab 80mg","code_information":[{"code":"CP17744631830804512","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714057001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pravastatin  Tab 80mg","code_information":[{"code":"CP17744631830801884","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729001115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pravastatin  Tab 80mg","code_information":[{"code":"CP17744631830806471","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505132305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pravastatin  Tab 80mg","code_information":[{"code":"CP17744631830801458","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505132309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pravastatin 40mg Tabs","code_information":[{"code":"CP17744631830802311","type":"CDM"},{"code":"250","type":"RC"},{"code":"93720","type":"CPT","modifier":"210"}],"standard_charges":[{"setting":"outpatient","modifier_code":["210"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pravastatin 40mg Tabs","code_information":[{"code":"CP17744631830804461","type":"CDM"},{"code":"250","type":"RC"},{"code":"93720","type":"CPT","modifier":"298"}],"standard_charges":[{"setting":"outpatient","modifier_code":["298"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sm Probiotic Cap 250mg","code_information":[{"code":"CP17744631831036068","type":"CDM"},{"code":"250","type":"RC"},{"code":"10939079044","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Telmisa/hctz Tab 80-12.5","code_information":[{"code":"CP17744631831106762","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332021030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Telmisa/hctz Tab 80-25mg","code_information":[{"code":"CP17744631831107245","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332021130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Terazosin    Cap 10mg","code_information":[{"code":"CP17744631831110559","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746038606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Terazosin    Cap 5mg","code_information":[{"code":"CP17744631831116434","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155073701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Valsartan    Tab 80mg","code_information":[{"code":"CP17744631831222041","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547036809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Zyrtec Allgy Cap 10mg","code_information":[{"code":"CP17744631831418648","type":"CDM"},{"code":"250","type":"RC"},{"code":"45020","type":"CPT","modifier":"425"}],"standard_charges":[{"setting":"outpatient","modifier_code":["425"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Advil Allerg Tab Congest","code_information":[{"code":"CP17744631828363926","type":"CDM"},{"code":"250","type":"RC"},{"code":"57301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alprazolam   Tab 0.25mg","code_information":[{"code":"CP17744631828448766","type":"CDM"},{"code":"250","type":"RC"},{"code":"78110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ativ1mg/benad25mg/hald1mg/1ml","code_information":[{"code":"CP17744631828772913","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657070401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Budesonide   Sus 0.25mg/2","code_information":[{"code":"CP17744631828957595","type":"CDM"},{"code":"250","type":"RC"},{"code":"11516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Budesonide   Sus 0.25mg/2","code_information":[{"code":"CP17744631828952481","type":"CDM"},{"code":"250","type":"RC"},{"code":"93681","type":"CPT","modifier":"573"}],"standard_charges":[{"setting":"outpatient","modifier_code":["573"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Candesa/hctz Tab 16-12.5","code_information":[{"code":"CP17744631829091503","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559066090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"EA"}},{"description":"Carb/levo 50 Tab /Entacap","code_information":[{"code":"CP17744631829110646","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571068901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Ceftriaxone  Inj 250mg","code_information":[{"code":"CP17744631829182631","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clozapine    Tab 200mg","code_information":[{"code":"CP17744631829392412","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862027401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Clozapine 200mg Tabs","code_information":[{"code":"CP17744631829394610","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862027401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Diclo/misopr Tab 75-0.2mg","code_information":[{"code":"CP17744631829599379","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762002901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Disopyramide Cap 100mg","code_information":[{"code":"CP17744631829708347","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762038601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Docu         Liq 50mg/5ml","code_information":[{"code":"CP17744631829710337","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383077116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Docusate 50mg/5ml Liquid","code_information":[{"code":"CP17744631829713523","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383077116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Doxepin Hcl  Cap 100mg","code_information":[{"code":"CP17744631829730825","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884022101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxepin Hcl  Cap 150mg","code_information":[{"code":"CP17744631829732553","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Fenofibrate  Tab 160mg","code_information":[{"code":"CP17744631829850349","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219552209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Fluocinonide Oin 0.05%","code_information":[{"code":"CP17744631829975380","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714050201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Oin 0.05%","code_information":[{"code":"CP17744631829973872","type":"CDM"},{"code":"250","type":"RC"},{"code":"70700014617","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Oin 0.05%","code_information":[{"code":"CP17744631829973551","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714050203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Oin 0.05%","code_information":[{"code":"CP17744631829975503","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Oin 0.05%","code_information":[{"code":"CP17744631829978687","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Haloperidol  Tab 10mg","code_information":[{"code":"CP17744631830061032","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657070401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Haloperidol  Tab 20mg","code_information":[{"code":"CP17744631830062635","type":"CDM"},{"code":"250","type":"RC"},{"code":"83215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Haloperidol 10mg Tabs","code_information":[{"code":"CP17744631830079552","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657070401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Haloperidol 5mg Tabs","code_information":[{"code":"CP17744631830071097","type":"CDM"},{"code":"250","type":"RC"},{"code":"37803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Insulin Syrg Mis 0.5/31g","code_information":[{"code":"CP17744631830143541","type":"CDM"},{"code":"250","type":"RC"},{"code":"94046000170","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Syrg Mis 1ml/30g","code_information":[{"code":"CP17744631830143821","type":"CDM"},{"code":"250","type":"RC"},{"code":"94046000162","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Insulin Syrg Mis 1ml/31g","code_information":[{"code":"CP17744631830153992","type":"CDM"},{"code":"250","type":"RC"},{"code":"94046000168","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830216856","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746024610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Lansoprazole Cap 15mg Dr","code_information":[{"code":"CP17744631830213653","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756080630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Lansoprazole Cap 30mg Dr","code_information":[{"code":"CP17744631830218756","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756080790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Levetiraceta Tab 1000mg","code_information":[{"code":"CP17744631830303661","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668001760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ME"}},{"description":"Levetiraceta Tab 750mg","code_information":[{"code":"CP17744631830307960","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722053812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiraceta Tab 750mg","code_information":[{"code":"CP17744631830300271","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862024708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiraceta Tab 750mg","code_information":[{"code":"CP17744631830309983","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiraceta Tab 750mg","code_information":[{"code":"CP17744631830302114","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571078912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiraceta Tab 750mg","code_information":[{"code":"CP17744631830309394","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Levetiracetam 750mg Tabs","code_information":[{"code":"CP17744631830309144","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":750,"type":"ME"}},{"description":"Lora1/diph25/halo1/1 Ml","code_information":[{"code":"CP17744631830366755","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657070401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Nadolol      Tab 40mg","code_information":[{"code":"CP17744631830534093","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382073301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830545399","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668035590","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830541545","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241003404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830544514","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547052609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 10mg","code_information":[{"code":"CP17744631830542022","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756029290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Nebivolol    Tab 2.5mg","code_information":[{"code":"CP17744631830544438","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241003222","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nebivolol    Tab 2.5mg","code_information":[{"code":"CP17744631830544163","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651013730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Nebivolol    Tab 20mg","code_information":[{"code":"CP17744631830548876","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651014090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nebivolol    Tab 5mg","code_information":[{"code":"CP17744631830544739","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651013830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Nebivolol    Tab 5mg","code_information":[{"code":"CP17744631830546885","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547052503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Np Thyroid   Tab 30mg","code_information":[{"code":"CP17744631830645800","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192032901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Pot Chloride Tab 10meq Er","code_information":[{"code":"CP17744631830794683","type":"CDM"},{"code":"250","type":"RC"},{"code":"70010013610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pot Citrate  Tab 1080mg","code_information":[{"code":"CP17744631830791374","type":"CDM"},{"code":"250","type":"RC"},{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1080,"type":"ME"}},{"description":"Ursodiol     Tab 500mg","code_information":[{"code":"CP17744631831214390","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380091906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ursodiol     Tab 500mg","code_information":[{"code":"CP17744631831218427","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884041301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Valsartan    Tab 160mg","code_information":[{"code":"CP17744631831227716","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877041790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Vancomycin   Sol 50mg/ml","code_information":[{"code":"CP17744631831237886","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536010810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"24 Hr Nasal  Spr Allergy","code_information":[{"code":"CP17744631828075277","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011032001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Spr 0.15%","code_information":[{"code":"CP17744631828807480","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505084805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828831772","type":"CDM"},{"code":"250","type":"RC"},{"code":"73320000304","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828839551","type":"CDM"},{"code":"250","type":"RC"},{"code":"11510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828831713","type":"CDM"},{"code":"250","type":"RC"},{"code":"60324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen     Tab 20mg","code_information":[{"code":"CP17744631828836125","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817032100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen 20mg Tabs","code_information":[{"code":"CP17744631828835240","type":"CDM"},{"code":"250","type":"RC"},{"code":"60324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Baclofen 5mg/ml Susp","code_information":[{"code":"CP17744631828836221","type":"CDM"},{"code":"250","type":"RC"},{"code":"60324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Baclofen 5mg/ml Susp","code_information":[{"code":"CP17744631828839766","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817032100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Budesonide   Sus 0.25mg/2","code_information":[{"code":"CP17744631828951827","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714001830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Cetirizine   Tab 10mg","code_information":[{"code":"CP17744631829205400","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714079903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Cloraz Dipot Tab 3.75mg","code_information":[{"code":"CP17744631829381941","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603011201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Codeine Sulf Tab 15mg","code_information":[{"code":"CP17744631829408156","type":"CDM"},{"code":"250","type":"RC"},{"code":"54024","type":"CPT","modifier":"324"}],"standard_charges":[{"setting":"outpatient","modifier_code":["324"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Diclofen Pot Tab 50mg","code_information":[{"code":"CP17744631829590938","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742027901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Easy Touch   Mis 29gx8mm","code_information":[{"code":"CP17744631829760657","type":"CDM"},{"code":"250","type":"RC"},{"code":"8496290801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eplerenone   Tab 25mg","code_information":[{"code":"CP17744631829796673","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991087790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Famotidine   Tab 40mg","code_information":[{"code":"CP17744631829841386","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710168400","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Tab 40mg","code_information":[{"code":"CP17744631829848672","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877084305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Tab 40mg","code_information":[{"code":"CP17744631829844482","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442012210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine 40mg Tabs","code_information":[{"code":"CP17744631829847166","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442012210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Foltrate     Tab","code_information":[{"code":"CP17744631829995889","type":"CDM"},{"code":"250","type":"RC"},{"code":"50991032301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentamicin   Cre 0.1%","code_information":[{"code":"CP17744631830021564","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565008515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloperidol  Tab 5mg","code_information":[{"code":"CP17744631830072555","type":"CDM"},{"code":"250","type":"RC"},{"code":"37803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hurricaine   Spr 20%","code_information":[{"code":"CP17744631830091294","type":"CDM"},{"code":"250","type":"RC"},{"code":"28306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Iodoform Pack Gauze 1/2","code_information":[{"code":"CP17744631830153485","type":"CDM"},{"code":"250","type":"RC"},{"code":"16784034122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iron         Chw Pediatri","code_information":[{"code":"CP17744631830162256","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269091060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iron Chews 15mg","code_information":[{"code":"CP17744631830169368","type":"CDM"},{"code":"250","type":"RC"},{"code":"61269091060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830309932","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383028608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Morphine Sul Tab 15mg Er","code_information":[{"code":"CP17744631830506130","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084015701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Mucinex      Tab 1200mg","code_information":[{"code":"CP17744631830511573","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824002336","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Nadolol      Tab 20mg","code_information":[{"code":"CP17744631830534835","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238112309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nasalcrom    Spr 5.2/act","code_information":[{"code":"CP17744631830544225","type":"CDM"},{"code":"250","type":"RC"},{"code":"14832001101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":52,"type":"EA"}},{"description":"Np Thyroid   Tab 60mg","code_information":[{"code":"CP17744631830646271","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192033001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Rivastigmine Cap 1.5mg","code_information":[{"code":"CP17744631830909916","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862064860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Rivastigmine Cap 3mg","code_information":[{"code":"CP17744631830902326","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862064960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rivastigmine Cap 4.5mg","code_information":[{"code":"CP17744631830901783","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862065060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Rivastigmine Cap 6mg","code_information":[{"code":"CP17744631830909761","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991079606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Rivastigmine Cap 6mg","code_information":[{"code":"CP17744631830902640","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862065160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Sotalol Hcl  Tab 80mg","code_information":[{"code":"CP17744631831052640","type":"CDM"},{"code":"250","type":"RC"},{"code":"93106","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Systane      Sol","code_information":[{"code":"CP17744631831099390","type":"CDM"},{"code":"250","type":"RC"},{"code":"65042","type":"CPT","modifier":"915"}],"standard_charges":[{"setting":"outpatient","modifier_code":["915"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Systane 0.3-0.4% Eye Drops","code_information":[{"code":"CP17744631831098042","type":"CDM"},{"code":"250","type":"RC"},{"code":"65042","type":"CPT","modifier":"915"}],"standard_charges":[{"setting":"outpatient","modifier_code":["915"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Systane Soln","code_information":[{"code":"CP17744631831093499","type":"CDM"},{"code":"250","type":"RC"},{"code":"65042","type":"CPT","modifier":"915"}],"standard_charges":[{"setting":"outpatient","modifier_code":["915"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Testosterone Gel 1%(50mg)","code_information":[{"code":"CP17744631831112607","type":"CDM"},{"code":"250","type":"RC"},{"code":"59132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Theratears   Sol Op","code_information":[{"code":"CP17744631831126353","type":"CDM"},{"code":"250","type":"RC"},{"code":"58790000115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thiothixene  Cap 5mg","code_information":[{"code":"CP17744631831128680","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219167501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831132221","type":"CDM"},{"code":"250","type":"RC"},{"code":"70069070601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Tobramycin 280mg/100ml Ns","code_information":[{"code":"CP17744631831148722","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323030630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":280,"type":"ME"}},{"description":"Vancomycin   Sol 25mg/ml","code_information":[{"code":"CP17744631831234311","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877075081","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Vazalore     Cap 81mg","code_information":[{"code":"CP17744631831252026","type":"CDM"},{"code":"250","type":"RC"},{"code":"73089008112","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":81,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831257150","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382003516","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831259198","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668001990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831251594","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382003510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831252779","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine  Cap 75mg Er","code_information":[{"code":"CP17744631831255404","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291089890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Venlafaxine Er 75mg Caps","code_information":[{"code":"CP17744631831266722","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382003510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Amox/k Clav  Sus 250/5ml","code_information":[{"code":"CP17744631828501031","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651002675","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Amox/k Clav  Sus 250/5ml","code_information":[{"code":"CP17744631828502827","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651002601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828993937","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Buspirone    Tab 5mg","code_information":[{"code":"CP17744631829003480","type":"CDM"},{"code":"250","type":"RC"},{"code":"93005","type":"CPT","modifier":"301"}],"standard_charges":[{"setting":"outpatient","modifier_code":["301"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Carb/levo    Tab 10-100mg","code_information":[{"code":"CP17744631829103563","type":"CDM"},{"code":"250","type":"RC"},{"code":"93970","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Celecoxib    Cap 100mg","code_information":[{"code":"CP17744631829184026","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332014131","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Celecoxib    Cap 100mg","code_information":[{"code":"CP17744631829188689","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668044105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Celecoxib    Cap 100mg","code_information":[{"code":"CP17744631829184515","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762151601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829244974","type":"CDM"},{"code":"250","type":"RC"},{"code":"14399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829244585","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862007601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Diclofenac   Sol 1.5%","code_information":[{"code":"CP17744631829592478","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162091174","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"EA"}},{"description":"Digoxin      Tab 0.125mg","code_information":[{"code":"CP17744631829602867","type":"CDM"},{"code":"250","type":"RC"},{"code":"82685020101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Diltiazem    Cap 420mg/24","code_information":[{"code":"CP17744631829690049","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682037290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":420,"type":"ME"}},{"description":"Fluphenazine Tab 1mg","code_information":[{"code":"CP17744631829980142","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238167801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Flurandrenol Lot 0.05%","code_information":[{"code":"CP17744631829983523","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802092803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Furosemide   Inj 10mg/ml","code_information":[{"code":"CP17744631830005649","type":"CDM"},{"code":"250","type":"RC"},{"code":"40961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ketoconazole Cre 2%","code_information":[{"code":"CP17744631830189843","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922002507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Ketoconazole Cre 2%","code_information":[{"code":"CP17744631830189222","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lamotrigine  Tab 100mg","code_information":[{"code":"CP17744631830216096","type":"CDM"},{"code":"250","type":"RC"},{"code":"90470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Md-gastrovie Sol 66-10%","code_information":[{"code":"CP17744631830403875","type":"CDM"},{"code":"250","type":"RC"},{"code":"19481","type":"CPT","modifier":"604"}],"standard_charges":[{"setting":"outpatient","modifier_code":["604"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":66,"type":"EA"}},{"description":"Mesalamine   Cap 0.375gm","code_information":[{"code":"CP17744631830423906","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Mesalamine   Cap 0.375gm","code_information":[{"code":"CP17744631830420591","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748021416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Mesalamine   Cap 0.375gm","code_information":[{"code":"CP17744631830425436","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651039708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Mesalamine   Cap 0.375gm","code_information":[{"code":"CP17744631830423643","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877071712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Mesalamine   Cap 0.375gm","code_information":[{"code":"CP17744631830420923","type":"CDM"},{"code":"250","type":"RC"},{"code":"37813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Mesalamine Er-0.375gm","code_information":[{"code":"CP17744631830436707","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748021416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"GR"}},{"description":"Metolazone   Tab 2.5mg","code_information":[{"code":"CP17744631830455658","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292056201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metronidazol Gel 1%","code_information":[{"code":"CP17744631830474431","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672421503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metronidazol Gel 1%","code_information":[{"code":"CP17744631830476769","type":"CDM"},{"code":"250","type":"RC"},{"code":"78170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metronidazol Gel 1%","code_information":[{"code":"CP17744631830471928","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332063060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metronidazole 1% Gel","code_information":[{"code":"CP17744631830479186","type":"CDM"},{"code":"250","type":"RC"},{"code":"78170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mycophenolic Acid 180mg Tabs","code_information":[{"code":"CP17744631830526793","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505296507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mycophenolic Tab 180mg Dr","code_information":[{"code":"CP17744631830529219","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505296507","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mycophenolic Tab 180mg Dr","code_information":[{"code":"CP17744631830523267","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436017223","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mycophenolic Tab 180mg Dr","code_information":[{"code":"CP17744631830520073","type":"CDM"},{"code":"250","type":"RC"},{"code":"70748021716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mycophenolic Tab 180mg Dr","code_information":[{"code":"CP17744631830520436","type":"CDM"},{"code":"250","type":"RC"},{"code":"37842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Mycophenolic Tab 180mg Dr","code_information":[{"code":"CP17744631830529178","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729026129","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830531682","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094090930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Rifampin     Cap 300mg","code_information":[{"code":"CP17744631830899389","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Rifampin     Cap 300mg","code_information":[{"code":"CP17744631830898481","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180065907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Rifampin     Cap 300mg","code_information":[{"code":"CP17744631830891987","type":"CDM"},{"code":"250","type":"RC"},{"code":"18507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Rifampin     Cap 300mg","code_information":[{"code":"CP17744631830890818","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180065906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Rifampin     Cap 300mg","code_information":[{"code":"CP17744631830896676","type":"CDM"},{"code":"250","type":"RC"},{"code":"18507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Tolterodine  Tab 1mg","code_information":[{"code":"CP17744631831146614","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762017006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Valsartan    Tab 80mg","code_information":[{"code":"CP17744631831221396","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877041690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Valsartan    Tab 80mg","code_information":[{"code":"CP17744631831222143","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746036190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Venlafaxine  Tab 100mg","code_information":[{"code":"CP17744631831250473","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664039688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Zolpidem     Tab 10mg","code_information":[{"code":"CP17744631831409317","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zolpidem     Tab 10mg","code_information":[{"code":"CP17744631831405003","type":"CDM"},{"code":"250","type":"RC"},{"code":"93007","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zolpidem     Tab 5mg","code_information":[{"code":"CP17744631831400047","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714062101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zolpidem     Tab 5mg","code_information":[{"code":"CP17744631831401968","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668000701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zolpidem     Tab 5mg","code_information":[{"code":"CP17744631831407361","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zolpidem 10mg Tabs","code_information":[{"code":"CP17744631831405329","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zolpidem 10mg Tabs","code_information":[{"code":"CP17744631831403879","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668000810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zolpidem 5mg Tabs","code_information":[{"code":"CP17744631831404870","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668000705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"60ml Syringe Mis Luer Slp","code_information":[{"code":"CP17744631828091001","type":"CDM"},{"code":"250","type":"RC"},{"code":"86227073605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ML"}},{"description":"Alprazolam   Tab 0.25mg","code_information":[{"code":"CP17744631828447136","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Alprazolam 0.25mg Tabs","code_information":[{"code":"CP17744631828458816","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bumetanide   Inj 1mg/4ml","code_information":[{"code":"CP17744631828960860","type":"CDM"},{"code":"250","type":"RC"},{"code":"70860040504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Buprenorphin Sub 2mg","code_information":[{"code":"CP17744631828986521","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383092493","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Calc Acetate Cap 667mg","code_information":[{"code":"CP17744631829056307","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084047901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":667,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829227709","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884046565","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Cholestyramine 4gm Pack","code_information":[{"code":"CP17744631829224433","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884046565","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Ciclopirox   Cre 0.77%","code_information":[{"code":"CP17744631829228664","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829245497","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714065102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clarithromyc Tab 250mg","code_information":[{"code":"CP17744631829245380","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237004460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clindamy/ben Gel 1.2-5%","code_information":[{"code":"CP17744631829258453","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922002206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Clobetasol   Cre 0.05%","code_information":[{"code":"CP17744631829261243","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559098060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol E Cre 0.05%","code_information":[{"code":"CP17744631829362422","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol E Cre 0.05%","code_information":[{"code":"CP17744631829367775","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol E Cre 0.05%","code_information":[{"code":"CP17744631829360613","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol E Cre 0.05%","code_information":[{"code":"CP17744631829366160","type":"CDM"},{"code":"250","type":"RC"},{"code":"16803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol E Cre 0.05%","code_information":[{"code":"CP17744631829368379","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559098060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clozapine    Tab 200mg","code_information":[{"code":"CP17744631829395309","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862090301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Dapsone      Tab 100mg","code_information":[{"code":"CP17744631829479178","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033003730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Diclofenac   Tab 25mg Dr","code_information":[{"code":"CP17744631829597500","type":"CDM"},{"code":"250","type":"RC"},{"code":"68001027900","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Entacapone   Tab 200mg","code_information":[{"code":"CP17744631829793248","type":"CDM"},{"code":"250","type":"RC"},{"code":"52718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Entacapone   Tab 200mg","code_information":[{"code":"CP17744631829791811","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862065401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Felbamate    Tab 400mg","code_information":[{"code":"CP17744631829849214","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672418501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Folbic       Tab","code_information":[{"code":"CP17744631829993543","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991038490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Folbic--tabs 2.5-25-2-2 Mg","code_information":[{"code":"CP17744631829997013","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991038490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Intrasite    Gel Applipak","code_information":[{"code":"CP17744631830153754","type":"CDM"},{"code":"250","type":"RC"},{"code":"22304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Labetalol    Tab 100mg","code_information":[{"code":"CP17744631830196175","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135071101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Labetalol    Tab 200mg","code_information":[{"code":"CP17744631830202294","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382079901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Methadone    Con 10mg/ml","code_information":[{"code":"CP17744631830448900","type":"CDM"},{"code":"250","type":"RC"},{"code":"54355","type":"CPT","modifier":"344"}],"standard_charges":[{"setting":"outpatient","modifier_code":["344"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Misoprostol  Tab 200mcg","code_information":[{"code":"CP17744631830490355","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386016106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Naproxen     Tab 500mg","code_information":[{"code":"CP17744631830536334","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Naproxen Sod Tab 550mg","code_information":[{"code":"CP17744631830548222","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598049501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Paroxetine   Tab 25mg Er","code_information":[{"code":"CP17744631830732319","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858070503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Poise Pads Max Conv 48's","code_information":[{"code":"CP17744631830786809","type":"CDM"},{"code":"250","type":"RC"},{"code":"3600047199","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Retaine Mgd  Emu 0.5-0.5%","code_information":[{"code":"CP17744631830894361","type":"CDM"},{"code":"250","type":"RC"},{"code":"15718091730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Timolol Mal  Sol 0.25% Op","code_information":[{"code":"CP17744631831139676","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758080205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Xerofrm Petr Pad 2\"x2\"","code_information":[{"code":"CP17744631831386719","type":"CDM"},{"code":"250","type":"RC"},{"code":"8080433401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betameth Val Cre 0.1%","code_information":[{"code":"CP17744631828874955","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betameth Val Cre 0.1%","code_information":[{"code":"CP17744631828876964","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bumetanide   Inj 0.25/ml","code_information":[{"code":"CP17744631828962072","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021032104","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Buprenorphin Sub 2mg","code_information":[{"code":"CP17744631828988320","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756045983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Carb/levo Er Tab 50-200mg","code_information":[{"code":"CP17744631829115606","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729007901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Carbamazepin Tab 200mg Er","code_information":[{"code":"CP17744631829123350","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cefuroxime   Tab 250mg","code_information":[{"code":"CP17744631829182947","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cholestyram  Pow 4gm Lite","code_information":[{"code":"CP17744631829223500","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382052960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829244997","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442022201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829243376","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571041110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829245075","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111012601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Clobetasol   Lot 0.05%","code_information":[{"code":"CP17744631829268819","type":"CDM"},{"code":"250","type":"RC"},{"code":"47204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol E Cre 0.05%","code_information":[{"code":"CP17744631829360386","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clonidine    Tab 0.1mg Er","code_information":[{"code":"CP17744631829383394","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241010806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonidine    Tab 0.1mg Er","code_information":[{"code":"CP17744631829383862","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547043506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonidine    Tab 0.1mg Er","code_information":[{"code":"CP17744631829387844","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742024760","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonidine Er 0.1mg","code_information":[{"code":"CP17744631829387933","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241010806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Culturelle   Pak Kids","code_information":[{"code":"CP17744631829436288","type":"CDM"},{"code":"250","type":"RC"},{"code":"49100040008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluocin Acet Sol 0.01%","code_information":[{"code":"CP17744631829975653","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629958401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Insulin Syrg Mis 0.5/31g","code_information":[{"code":"CP17744631830142868","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290328290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 25mg","code_information":[{"code":"CP17744631830211371","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672413001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine 25mg Tabs","code_information":[{"code":"CP17744631830210563","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672413001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Levetiraceta Tab 500mg Er","code_information":[{"code":"CP17744631830309443","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180011707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg Er","code_information":[{"code":"CP17744631830309029","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547034506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg Er","code_information":[{"code":"CP17744631830307908","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228018960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg Er","code_information":[{"code":"CP17744631830305036","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505328006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiracetam Er 500mg Tabs","code_information":[{"code":"CP17744631830305972","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180011707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiracetam Er 500mg Tabs","code_information":[{"code":"CP17744631830306760","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547034506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levocarnitin Tab 330mg","code_information":[{"code":"CP17744631830302048","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954049210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Levofloxacin Sol 25mg/ml","code_information":[{"code":"CP17744631830305573","type":"CDM"},{"code":"250","type":"RC"},{"code":"50383028616","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lidocaine    Inj 1%","code_information":[{"code":"CP17744631830332524","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Inj 2%","code_information":[{"code":"CP17744631830334297","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150016402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lidocaine 1% Inj","code_information":[{"code":"CP17744631830335506","type":"CDM"},{"code":"250","type":"RC"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lorazepam    Tab 0.5mg","code_information":[{"code":"CP17744631830365366","type":"CDM"},{"code":"250","type":"RC"},{"code":"93342","type":"CPT","modifier":"501"}],"standard_charges":[{"setting":"outpatient","modifier_code":["501"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lo-zumandimi Tab 3-0.02mg","code_information":[{"code":"CP17744631830380541","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651002988","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Luer-lok Syr Mis 1ml/20g","code_information":[{"code":"CP17744631830382050","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290309637","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Methenam Man Tab 500mg","code_information":[{"code":"CP17744631830443000","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657046001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Morphine Sul Tab 30mg","code_information":[{"code":"CP17744631830506353","type":"CDM"},{"code":"250","type":"RC"},{"code":"83202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Mucinex Fast Max","code_information":[{"code":"CP17744631830511276","type":"CDM"},{"code":"250","type":"RC"},{"code":"36382419320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mucinex Fast Tab 5-10-200","code_information":[{"code":"CP17744631830518567","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824019320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Mucus-dm Max Tab 60-1200","code_information":[{"code":"CP17744631830516179","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122063774","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"No-sting     Mis Skinprep","code_information":[{"code":"CP17744631830573177","type":"CDM"},{"code":"250","type":"RC"},{"code":"40565011673","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles  Mis 32gx4mm","code_information":[{"code":"CP17744631830743979","type":"CDM"},{"code":"250","type":"RC"},{"code":"8222095459","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles  Mis 32gx4mm","code_information":[{"code":"CP17744631830742902","type":"CDM"},{"code":"250","type":"RC"},{"code":"57515009545","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Piroxicam    Cap 20mg","code_information":[{"code":"CP17744631830784696","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571017701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Podiapn      Cap","code_information":[{"code":"CP17744631830780408","type":"CDM"},{"code":"250","type":"RC"},{"code":"53731000206","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prevacid 24h Cap 15mg Dr","code_information":[{"code":"CP17744631830827310","type":"CDM"},{"code":"250","type":"RC"},{"code":"67628","type":"CPT","modifier":"614"}],"standard_charges":[{"setting":"outpatient","modifier_code":["614"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Prevail Undr Mis S/m","code_information":[{"code":"CP17744631830825883","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891094552","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Propranolol  Tab 80mg","code_information":[{"code":"CP17744631830857068","type":"CDM"},{"code":"250","type":"RC"},{"code":"59155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Tacrolimus   Cap 0.5mg","code_information":[{"code":"CP17744631831095077","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380072006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831094806","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111052601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831091680","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462068601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831097202","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377001511","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831097167","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729004201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tacrolimus   Cap 1mg","code_information":[{"code":"CP17744631831091788","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380072106","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tacrolimus 1mg Caps","code_information":[{"code":"CP17744631831094314","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729004201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Topiramate   Tab 50mg","code_information":[{"code":"CP17744631831154920","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Topiramate 50mg Tabs","code_information":[{"code":"CP17744631831150069","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Torsemide    Tab 5mg","code_information":[{"code":"CP17744631831157684","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722052901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tranylcyprom Tab 10mg","code_information":[{"code":"CP17744631831167910","type":"CDM"},{"code":"250","type":"RC"},{"code":"59155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Triamcinalone 55mcg Spray","code_information":[{"code":"CP17744631831175614","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000020401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":55,"type":"ME"}},{"description":"Utility Drape W/tape15x26","code_information":[{"code":"CP17744631831214000","type":"CDM"},{"code":"250","type":"RC"},{"code":"11308","type":"CPT","modifier":"2"}],"standard_charges":[{"setting":"outpatient","modifier_code":["2"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valsart/hctz Tab 160-25mg","code_information":[{"code":"CP17744631831225956","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547031309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Vitamin E    Dro 15/0.3ml","code_information":[{"code":"CP17744631831301870","type":"CDM"},{"code":"250","type":"RC"},{"code":"71321080230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Zicam Extreme Congst Spr","code_information":[{"code":"CP17744631831390848","type":"CDM"},{"code":"250","type":"RC"},{"code":"62750000510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"3ml Syringe  Mis 22gx1.5\"","code_information":[{"code":"CP17744631828096758","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305272","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"3ml Syringe  Mis 23gx1\"","code_information":[{"code":"CP17744631828098432","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305271","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Alendronate  Sol 70/75ml","code_information":[{"code":"CP17744631828407095","type":"CDM"},{"code":"250","type":"RC"},{"code":"54028","type":"CPT","modifier":"259"}],"standard_charges":[{"setting":"outpatient","modifier_code":["259"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ML"}},{"description":"Aller/conges Tab 10-240mg","code_information":[{"code":"CP17744631828416266","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122016752","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Bupropn Hcl  Tab 150mg Xl","code_information":[{"code":"CP17744631828998358","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436001002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Cefprozil    Tab 250mg","code_information":[{"code":"CP17744631829173181","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237003601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cefprozil    Tab 250mg","code_information":[{"code":"CP17744631829170169","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714039801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Ceftriaxone  Inj 500mg","code_information":[{"code":"CP17744631829181365","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ceftriaxone 500mg/50ml Ns Mb+","code_information":[{"code":"CP17744631829181088","type":"CDM"},{"code":"250","type":"RC"},{"code":"40973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefuroxime   Tab 250mg","code_information":[{"code":"CP17744631829189626","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237005860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cefuroxime   Tab 250mg","code_information":[{"code":"CP17744631829182407","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862069960","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cefuroxime   Tab 250mg","code_information":[{"code":"CP17744631829182322","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180030260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Contour Next Tst/strp 50","code_information":[{"code":"CP17744631829419786","type":"CDM"},{"code":"250","type":"RC"},{"code":"19373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cromolyn Sod Sol 4% Op","code_information":[{"code":"CP17744631829433851","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314023710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Epinephrine  Inj 1mg/10ml","code_information":[{"code":"CP17744631829797341","type":"CDM"},{"code":"250","type":"RC"},{"code":"40949","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Etodolac Er  Tab 600mg","code_information":[{"code":"CP17744631829822591","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714049901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Filter Straw","code_information":[{"code":"CP17744631829950781","type":"CDM"},{"code":"250","type":"RC"},{"code":"8021415021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluphenazine Tab 1mg","code_information":[{"code":"CP17744631829984324","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714000201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fluphenazine Tab 1mg","code_information":[{"code":"CP17744631829985394","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fluphenazine Tab 1mg","code_information":[{"code":"CP17744631829988191","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954027310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Guanfacine   Tab 1mg","code_information":[{"code":"CP17744631830063468","type":"CDM"},{"code":"250","type":"RC"},{"code":"59104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Hyosyne      Dro 0.125/ml","code_information":[{"code":"CP17744631830121898","type":"CDM"},{"code":"250","type":"RC"},{"code":"54838050615","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketoconazole Tab 200mg","code_information":[{"code":"CP17744631830192929","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672402601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Misoprostol  Tab 200mcg","code_information":[{"code":"CP17744631830498882","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954044420","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Mood Plus    Tab 200mg","code_information":[{"code":"CP17744631830507029","type":"CDM"},{"code":"250","type":"RC"},{"code":"31604001091","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Mupirocin    Cre 2%","code_information":[{"code":"CP17744631830524733","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802001814","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Nitrofura Monohyd-macro 100mg","code_information":[{"code":"CP17744631830566806","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603019601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitrofurantn Cap 100mg","code_information":[{"code":"CP17744631830565551","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603019601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitrofurantoin Mono-mcr 100mg","code_information":[{"code":"CP17744631830569180","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603019601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nortriptylin Cap 25mg","code_information":[{"code":"CP17744631830570777","type":"CDM"},{"code":"250","type":"RC"},{"code":"93081","type":"CPT","modifier":"101"}],"standard_charges":[{"setting":"outpatient","modifier_code":["101"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830710209","type":"CDM"},{"code":"250","type":"RC"},{"code":"90470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Phenytoin Ex Cap 200mg","code_information":[{"code":"CP17744631830764934","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756029988","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Proctozone   Cre -Hc 2.5%","code_information":[{"code":"CP17744631830832173","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Proferrin-   Tab Forte","code_information":[{"code":"CP17744631830836486","type":"CDM"},{"code":"250","type":"RC"},{"code":"67181021690","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Refresh Opti Dro 0.5-0.9%","code_information":[{"code":"CP17744631830882728","type":"CDM"},{"code":"250","type":"RC"},{"code":"23324","type":"CPT","modifier":"15"}],"standard_charges":[{"setting":"outpatient","modifier_code":["15"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Refresh Optive Sol","code_information":[{"code":"CP17744631830883382","type":"CDM"},{"code":"250","type":"RC"},{"code":"23324","type":"CPT","modifier":"15"}],"standard_charges":[{"setting":"outpatient","modifier_code":["15"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Syringe/safety Needl 3ml 22gx1","code_information":[{"code":"CP17744631831097572","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305272","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Syringe/safety Needl 3ml 23gx1","code_information":[{"code":"CP17744631831097754","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305271","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Syringe/safety Needl 3ml 25gx1","code_information":[{"code":"CP17744631831099500","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305270","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ML"}},{"description":"Timolol Mal  Sol 0.5% Op","code_information":[{"code":"CP17744631831139399","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758080110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Tizanidine   Tab 4mg","code_information":[{"code":"CP17744631831138599","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714017202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine   Tab 4mg","code_information":[{"code":"CP17744631831139426","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578009721","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine Hcl Tab 4mg","code_information":[{"code":"CP17744631831140272","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714017202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Valsart/hctz Tab 80-12.5","code_information":[{"code":"CP17744631831225150","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332007990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Valsartan/hydro 80-12.5-tab","code_information":[{"code":"CP17744631831220748","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332007990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Zonisamide   Cap 100mg","code_information":[{"code":"CP17744631831416267","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462013005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amphet/dextr Cap 30mg Er","code_information":[{"code":"CP17744631828518304","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858093001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Amphet/dextr Tab 30mg","code_information":[{"code":"CP17744631828529332","type":"CDM"},{"code":"250","type":"RC"},{"code":"52707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"But/asa/caf/ Cap Codeine","code_information":[{"code":"CP17744631829047040","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238199301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Calc Acetate Cap 667mg","code_information":[{"code":"CP17744631829052154","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135019122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":667,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829220130","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224001120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Dapsone      Tab 100mg","code_information":[{"code":"CP17744631829479584","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980056601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dexamethason Tab 4mg","code_information":[{"code":"CP17744631829574579","type":"CDM"},{"code":"250","type":"RC"},{"code":"54817","type":"CPT","modifier":"525"}],"standard_charges":[{"setting":"outpatient","modifier_code":["525"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Diclofenac   Tab 25mg Dr","code_information":[{"code":"CP17744631829595974","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571020310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diclofenac Dr 25mg Tabs","code_information":[{"code":"CP17744631829590391","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571020310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Erythrom Eth Sus 200/5ml","code_information":[{"code":"CP17744631829806427","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536013413","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Erythrom Eth Sus 200/5ml","code_information":[{"code":"CP17744631829804185","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238150301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Erythrom Eth Sus 200/5ml","code_information":[{"code":"CP17744631829804052","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219150301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Flecainide   Tab 150mg","code_information":[{"code":"CP17744631829958279","type":"CDM"},{"code":"250","type":"RC"},{"code":"54001","type":"CPT","modifier":"221"}],"standard_charges":[{"setting":"outpatient","modifier_code":["221"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Gentamicin   Sol 0.3% Op","code_information":[{"code":"CP17744631830021417","type":"CDM"},{"code":"250","type":"RC"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Halobetasol  Oin 0.05%","code_information":[{"code":"CP17744631830068750","type":"CDM"},{"code":"250","type":"RC"},{"code":"71303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hm Lidocaine Pad 4%","code_information":[{"code":"CP17744631830086648","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011041501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocolloid 4x4 Sq","code_information":[{"code":"CP17744631830106323","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247919282","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830115038","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571068701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830117773","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382009601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830116228","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238154401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Iv Introcan Cath 22g-1","code_information":[{"code":"CP17744631830179623","type":"CDM"},{"code":"250","type":"RC"},{"code":"42535","type":"CPT","modifier":"40"}],"standard_charges":[{"setting":"outpatient","modifier_code":["40"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 25mg","code_information":[{"code":"CP17744631830211843","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine 25mg Tabs","code_information":[{"code":"CP17744631830210862","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714070001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Luvena Moist Gel Lubrican","code_information":[{"code":"CP17744631830387048","type":"CDM"},{"code":"250","type":"RC"},{"code":"99655000211","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metoclopram  Inj 10mg/2ml","code_information":[{"code":"CP17744631830454303","type":"CDM"},{"code":"250","type":"RC"},{"code":"40934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Metoclopram  Inj 5mg/ml","code_information":[{"code":"CP17744631830457182","type":"CDM"},{"code":"250","type":"RC"},{"code":"40934","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Midazolam    Inj 50/10ml","code_information":[{"code":"CP17744631830483949","type":"CDM"},{"code":"250","type":"RC"},{"code":"40925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ML"}},{"description":"Midazolam    Inj 50mg/10","code_information":[{"code":"CP17744631830485990","type":"CDM"},{"code":"250","type":"RC"},{"code":"40925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Midazolam 0.5mg/0.1ml Spray","code_information":[{"code":"CP17744631830482063","type":"CDM"},{"code":"250","type":"RC"},{"code":"40925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Move Free    Tab Ultra","code_information":[{"code":"CP17744631830511520","type":"CDM"},{"code":"250","type":"RC"},{"code":"20525011841","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Naproxen Dr 500mg Tabs","code_information":[{"code":"CP17744631830548837","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097085207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Phenytoin    Sus 125/5ml","code_information":[{"code":"CP17744631830769468","type":"CDM"},{"code":"250","type":"RC"},{"code":"66689003650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Prednisolone Sol 15mg/5ml","code_information":[{"code":"CP17744631830818430","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Rapidfill Connector Ll-ll","code_information":[{"code":"CP17744631830871015","type":"CDM"},{"code":"250","type":"RC"},{"code":"17191013901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Setlakin     Tab","code_information":[{"code":"CP17744631831008498","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714036603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sulfasalazin Tab 500mg","code_information":[{"code":"CP17744631831076663","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135096001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831109041","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547028503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Telmisartan  Tab 80mg","code_information":[{"code":"CP17744631831108282","type":"CDM"},{"code":"250","type":"RC"},{"code":"78153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Toothbrush Soft","code_information":[{"code":"CP17744631831152336","type":"CDM"},{"code":"250","type":"RC"},{"code":"78300000021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tranylcypromine 10mg Tabs","code_information":[{"code":"CP17744631831162330","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zyrtec Allgy Tab 10mg","code_information":[{"code":"CP17744631831412574","type":"CDM"},{"code":"250","type":"RC"},{"code":"50580072636","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Acetazolamid Cap 500mg Er","code_information":[{"code":"CP17744631828256794","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155012001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetazolamid Cap 500mg Er","code_information":[{"code":"CP17744631828259774","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729033101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetazolamid Cap 500mg Er","code_information":[{"code":"CP17744631828255799","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571024301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetazolamid Cap 500mg Er","code_information":[{"code":"CP17744631828259705","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetazolamide  Er-500mg Cap","code_information":[{"code":"CP17744631828254759","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Acetazolamide Er 500mg Caps","code_information":[{"code":"CP17744631828264698","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033003001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Beneprotein  Pow","code_information":[{"code":"CP17744631828851400","type":"CDM"},{"code":"250","type":"RC"},{"code":"43900028430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Benzonatate  Cap 200mg","code_information":[{"code":"CP17744631828862981","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380071307","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Benzonatate  Cap 200mg","code_information":[{"code":"CP17744631828865233","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452014430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Betameth Dip Aug 0.05% Oint","code_information":[{"code":"CP17744631828861403","type":"CDM"},{"code":"250","type":"RC"},{"code":"66993089749","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Betameth Val Cre 0.1%","code_information":[{"code":"CP17744631828872755","type":"CDM"},{"code":"250","type":"RC"},{"code":"47203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bethanechol  Tab 50mg","code_information":[{"code":"CP17744631828871533","type":"CDM"},{"code":"250","type":"RC"},{"code":"83205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bethanechol 50mg Tabs","code_information":[{"code":"CP17744631828871952","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980016301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Calmol-4     Sup","code_information":[{"code":"CP17744631829098851","type":"CDM"},{"code":"250","type":"RC"},{"code":"67492010411","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carafate     Sus 1gm/10ml","code_information":[{"code":"CP17744631829109181","type":"CDM"},{"code":"250","type":"RC"},{"code":"58914017014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Carafate 1gm/10ml Susp","code_information":[{"code":"CP17744631829108756","type":"CDM"},{"code":"250","type":"RC"},{"code":"58914017014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Cetiriz/pse  Tab 5-120mg","code_information":[{"code":"CP17744631829202780","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802014762","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cetirizine-pse Er 5-120mg Tab","code_information":[{"code":"CP17744631829205094","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802014762","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chlorpromaz  Tab 10mg","code_information":[{"code":"CP17744631829213933","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332073531","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 10mg","code_information":[{"code":"CP17744631829212595","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714004701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 10mg","code_information":[{"code":"CP17744631829217647","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462086101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 10mg","code_information":[{"code":"CP17744631829213948","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710112901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 10mg","code_information":[{"code":"CP17744631829212119","type":"CDM"},{"code":"250","type":"RC"},{"code":"52729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Chlorpromaz  Tab 10mg","code_information":[{"code":"CP17744631829214559","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238105401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clindamycin  Gel 1%","code_information":[{"code":"CP17744631829250249","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762374301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clonazepam   Tab 1mg","code_information":[{"code":"CP17744631829370626","type":"CDM"},{"code":"250","type":"RC"},{"code":"93321","type":"CPT","modifier":"201"}],"standard_charges":[{"setting":"outpatient","modifier_code":["201"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clozapine    Tab 200mg","code_information":[{"code":"CP17744631829395548","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862090305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Colesevelam 625mg Tabs","code_information":[{"code":"CP17744631829408124","type":"CDM"},{"code":"250","type":"RC"},{"code":"51660099628","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Daily Probiotic","code_information":[{"code":"CP17744631829465501","type":"CDM"},{"code":"250","type":"RC"},{"code":"31917207322","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Diphenhydram Inj 50mg/ml","code_information":[{"code":"CP17744631829700075","type":"CDM"},{"code":"250","type":"RC"},{"code":"64103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Docusol Kids Ene 100mg/5m","code_information":[{"code":"CP17744631829716015","type":"CDM"},{"code":"250","type":"RC"},{"code":"17433988405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Earache      Dro","code_information":[{"code":"CP17744631829761499","type":"CDM"},{"code":"250","type":"RC"},{"code":"54973041241","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluvoxamine  Tab 100mg","code_information":[{"code":"CP17744631829981946","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559016001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Glyburid Mcr Tab 6mg","code_information":[{"code":"CP17744631830059654","type":"CDM"},{"code":"250","type":"RC"},{"code":"93803","type":"CPT","modifier":"601"}],"standard_charges":[{"setting":"outpatient","modifier_code":["601"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Hear Aid Bat Mis Size 312","code_information":[{"code":"CP17744631830079361","type":"CDM"},{"code":"250","type":"RC"},{"code":"41333063387","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydralazine  Tab 25mg","code_information":[{"code":"CP17744631830090707","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228018310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Isosorb Mono Tab 60mg Er","code_information":[{"code":"CP17744631830167302","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742017601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Kt Tape Gntl Tap 10\"pre","code_information":[{"code":"CP17744631830199712","type":"CDM"},{"code":"250","type":"RC"},{"code":"14179002126","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Labetalol    Tab 200mg","code_information":[{"code":"CP17744631830204022","type":"CDM"},{"code":"250","type":"RC"},{"code":"70377006113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Leucovor Ca  Tab 5mg","code_information":[{"code":"CP17744631830295889","type":"CDM"},{"code":"250","type":"RC"},{"code":"54449","type":"CPT","modifier":"613"}],"standard_charges":[{"setting":"outpatient","modifier_code":["613"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lidocain/traim/nystatin/ssd","code_information":[{"code":"CP17744631830328456","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Gel 2% Jelly","code_information":[{"code":"CP17744631830333056","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Lidocaine  Jelly-2% *Not Avail","code_information":[{"code":"CP17744631830336967","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine 2% Jelly","code_information":[{"code":"CP17744631830339087","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lovastatin   Tab 40mg","code_information":[{"code":"CP17744631830371873","type":"CDM"},{"code":"250","type":"RC"},{"code":"93092","type":"CPT","modifier":"806"}],"standard_charges":[{"setting":"outpatient","modifier_code":["806"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Lovastatin 40mg Tabs","code_information":[{"code":"CP17744631830370171","type":"CDM"},{"code":"250","type":"RC"},{"code":"93092","type":"CPT","modifier":"806"}],"standard_charges":[{"setting":"outpatient","modifier_code":["806"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Meloxicam 15mg Tabs","code_information":[{"code":"CP17744631830415720","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442012710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Morphine Sul Er 30mg Tabs","code_information":[{"code":"CP17744631830501692","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858080201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Morphine Sul Tab 30mg Er","code_information":[{"code":"CP17744631830507538","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858080201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830537855","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729008101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Oxycodone    Tab 10mg","code_information":[{"code":"CP17744631830717084","type":"CDM"},{"code":"250","type":"RC"},{"code":"40685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Rivastigmine Cap 1.5mg","code_information":[{"code":"CP17744631830909135","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111035260","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Rivastigmine Cap 3mg","code_information":[{"code":"CP17744631830903875","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111035360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rivastigmine Cap 4.5mg","code_information":[{"code":"CP17744631830906657","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111035460","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Rivastigmine Cap 6mg","code_information":[{"code":"CP17744631830903800","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111035560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Sotalol *Af* 120 Mg Tablet","code_information":[{"code":"CP17744631831050600","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505022301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Sotalol Af   Tab 120mg","code_information":[{"code":"CP17744631831058568","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505022301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Sotalol Hcl  Tab 160mg","code_information":[{"code":"CP17744631831053947","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505008100","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Spironolact  Tab 100mg","code_information":[{"code":"CP17744631831051192","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603013601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Theophylline Tab 300mg Er","code_information":[{"code":"CP17744631831126137","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452026720","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Valsart/hctz Tab 160-12.5","code_information":[{"code":"CP17744631831226631","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332008090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Valsartan/hctz 160/12.5mg Tabs","code_information":[{"code":"CP17744631831224393","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862054890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"24 Hr Nasal  Spr Allergy","code_information":[{"code":"CP17744631828070193","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122038576","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Tab 800mg","code_information":[{"code":"CP17744631828335591","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505530701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Adapta Cap","code_information":[{"code":"CP17744631828344553","type":"CDM"},{"code":"250","type":"RC"},{"code":"19791979197","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alfuzosin    Tab 10mg Er","code_information":[{"code":"CP17744631828407242","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300015501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Alfuzosin    Tab 10mg Er","code_information":[{"code":"CP17744631828402783","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300015519","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Alfuzosin    Tab 10mg Er","code_information":[{"code":"CP17744631828402225","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335095688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Alfuzosin    Tab 10mg Er","code_information":[{"code":"CP17744631828404005","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237011490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Candesartan  Tab 32mg","code_information":[{"code":"CP17744631829098937","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332006090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":32,"type":"ME"}},{"description":"Chlorpromaz  Tab 10mg","code_information":[{"code":"CP17744631829219502","type":"CDM"},{"code":"250","type":"RC"},{"code":"83260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ciprofloxacn Tab 250mg","code_information":[{"code":"CP17744631829243995","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442022210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Cyclosporine Cap 50mg Mod","code_information":[{"code":"CP17744631829441990","type":"CDM"},{"code":"250","type":"RC"},{"code":"93901","type":"CPT","modifier":"965"}],"standard_charges":[{"setting":"outpatient","modifier_code":["965"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Dantrolene   Cap 50mg","code_information":[{"code":"CP17744631829477222","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884036301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Domeboro     Pow Packets","code_information":[{"code":"CP17744631829728825","type":"CDM"},{"code":"250","type":"RC"},{"code":"57074000177","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Domeboro Pd Pkts 2.7gm 12","code_information":[{"code":"CP17744631829720428","type":"CDM"},{"code":"250","type":"RC"},{"code":"16864024001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":27,"type":"GR"}},{"description":"Doxycyc Mono Tab 100mg","code_information":[{"code":"CP17744631829734456","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Doxycycline Mono 100mg Tabs","code_information":[{"code":"CP17744631829746873","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Ds Duragel Corn Cushion 6","code_information":[{"code":"CP17744631829759023","type":"CDM"},{"code":"250","type":"RC"},{"code":"88885300121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Earache      Dro","code_information":[{"code":"CP17744631829763732","type":"CDM"},{"code":"250","type":"RC"},{"code":"54973317201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Eplerenone   Tab 25mg","code_information":[{"code":"CP17744631829795084","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991087733","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Eplerenone   Tab 50mg","code_information":[{"code":"CP17744631829796720","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991087890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Eplerenone   Tab 50mg","code_information":[{"code":"CP17744631829794203","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991087833","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Fluoxetine   Tab 10mg","code_information":[{"code":"CP17744631829970137","type":"CDM"},{"code":"250","type":"RC"},{"code":"83204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829978542","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332024331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829970691","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180099901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829971654","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180099906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829977854","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651030901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829979158","type":"CDM"},{"code":"250","type":"RC"},{"code":"83204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829975328","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884033611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829971662","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884033601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829970111","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598056601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine   Tab 20mg","code_information":[{"code":"CP17744631829978771","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651030930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine 20mg Tabs","code_information":[{"code":"CP17744631829972384","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884033601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fluoxetine 20mg Tabs","code_information":[{"code":"CP17744631829973291","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332024331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Fortfy Daily Cap Probioti","code_information":[{"code":"CP17744631829996986","type":"CDM"},{"code":"250","type":"RC"},{"code":"33674010294","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gen Pur Syr 20ml Luer Lok","code_information":[{"code":"CP17744631830025621","type":"CDM"},{"code":"250","type":"RC"},{"code":"12544218132","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ML"}},{"description":"Glip/metform Tab 5-500mg","code_information":[{"code":"CP17744631830042300","type":"CDM"},{"code":"250","type":"RC"},{"code":"93745","type":"CPT","modifier":"701"}],"standard_charges":[{"setting":"outpatient","modifier_code":["701"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Iv Cadd Admin Set","code_information":[{"code":"CP17744631830177487","type":"CDM"},{"code":"250","type":"RC"},{"code":"10021732224","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 25mg","code_information":[{"code":"CP17744631830217529","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine  Tab 25mg","code_information":[{"code":"CP17744631830212370","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300011105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Loratadine   Tab 10mg","code_information":[{"code":"CP17744631830368501","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888002911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Loratadine-d Tab 5-120mg","code_information":[{"code":"CP17744631830366291","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802012265","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lutein       Cap 40mg","code_information":[{"code":"CP17744631830380365","type":"CDM"},{"code":"250","type":"RC"},{"code":"74312044250","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Methenam Hip Tab 1gm","code_information":[{"code":"CP17744631830446609","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862078201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830538463","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094090950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Niacin Er    Tab 500mg","code_information":[{"code":"CP17744631830557845","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335053981","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Nortriptylin Cap 75mg","code_information":[{"code":"CP17744631830575046","type":"CDM"},{"code":"250","type":"RC"},{"code":"75907007201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Ofloxacin    Dro 0.3% Op","code_information":[{"code":"CP17744631830667217","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478071310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxazepam     Cap 15mg","code_information":[{"code":"CP17744631830705451","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817029110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pantoprazole 40mg/100ml Ns","code_information":[{"code":"CP17744631830730284","type":"CDM"},{"code":"250","type":"RC"},{"code":"14392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Propranolol  Tab 80mg","code_information":[{"code":"CP17744631830859908","type":"CDM"},{"code":"250","type":"RC"},{"code":"69292053801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Rivastigmine 1.5mg Caps","code_information":[{"code":"CP17744631830900235","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756014586","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Rivastigmine 4.5mg Caps","code_information":[{"code":"CP17744631830903920","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756014786","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Sotalol Af   Tab 80mg","code_information":[{"code":"CP17744631831059881","type":"CDM"},{"code":"250","type":"RC"},{"code":"76385012501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Sucralfate   Sus 1gm/10ml","code_information":[{"code":"CP17744631831070755","type":"CDM"},{"code":"250","type":"RC"},{"code":"12109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Sucralfate   Sus 1gm/10ml","code_information":[{"code":"CP17744631831070720","type":"CDM"},{"code":"250","type":"RC"},{"code":"12109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831095169","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802070001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Oin 0.1%","code_information":[{"code":"CP17744631831092986","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802070000","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tamsulosin   Cap 0.4mg","code_information":[{"code":"CP17744631831102960","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862059805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin   Cap 0.4mg","code_information":[{"code":"CP17744631831103048","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603011502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin   Cap 0.4mg","code_information":[{"code":"CP17744631831106256","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756016013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin   Cap 0.4mg","code_information":[{"code":"CP17744631831107717","type":"CDM"},{"code":"250","type":"RC"},{"code":"22829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin   Cap 0.4mg","code_information":[{"code":"CP17744631831107850","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756016088","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin 0.4mg Caps","code_information":[{"code":"CP17744631831103040","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756016088","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin 0.4mg Caps","code_information":[{"code":"CP17744631831100234","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756016013","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin 0.4mg Caps","code_information":[{"code":"CP17744631831105460","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877045001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tamsulosin Cp 0.4mg","code_information":[{"code":"CP17744631831106249","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862059805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tretinoin    Cre 0.025%","code_information":[{"code":"CP17744631831175084","type":"CDM"},{"code":"250","type":"RC"},{"code":"57422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Triamcinolone Acet 55mcg/spray","code_information":[{"code":"CP17744631831189436","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122038576","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":55,"type":"ME"}},{"description":"Vicks Vapopads","code_information":[{"code":"CP17744631831267201","type":"CDM"},{"code":"250","type":"RC"},{"code":"32878599019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adaptic Non-adhering Dres","code_information":[{"code":"CP17744631828344050","type":"CDM"},{"code":"250","type":"RC"},{"code":"38137002012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bd Hypo Need Mis 23gx1\"","code_information":[{"code":"CP17744631828843001","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305193","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bromocriptin Tab 2.5mg","code_information":[{"code":"CP17744631828958894","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304096230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Bumetanide   Tab 2mg","code_information":[{"code":"CP17744631828965415","type":"CDM"},{"code":"250","type":"RC"},{"code":"42799012101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Carbamazepin Tab 400mg Er","code_information":[{"code":"CP17744631829122262","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672412501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Carbamazepin Tab 400mg Er","code_information":[{"code":"CP17744631829124559","type":"CDM"},{"code":"250","type":"RC"},{"code":"78159","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Carbamazepin Tab 400mg Er","code_information":[{"code":"CP17744631829125373","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746079101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Carbamazepin Tab 400mg Er","code_information":[{"code":"CP17744631829127823","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382055701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Carbamazepin Tab 400mg Er","code_information":[{"code":"CP17744631829128348","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571068201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Carbamazepine Er 400mg Tabs","code_information":[{"code":"CP17744631829127174","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672412501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829221660","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382052860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Clobetasol   Sol 0.05%","code_information":[{"code":"CP17744631829369030","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332048625","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Sol 0.05%","code_information":[{"code":"CP17744631829366036","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462053253","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Sol 0.05%","code_information":[{"code":"CP17744631829361747","type":"CDM"},{"code":"250","type":"RC"},{"code":"43386002860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Sol 0.05%","code_information":[{"code":"CP17744631829360791","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332048650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Sol 0.05%","code_information":[{"code":"CP17744631829363899","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571036299","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clobetasol   Sol 0.05%","code_information":[{"code":"CP17744631829368684","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342032186","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Digoxin      Tab 0.25mg","code_information":[{"code":"CP17744631829608142","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714059101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dorzolamide  Sol 2% Op","code_information":[{"code":"CP17744631829729920","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315030410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Doxycyc Mono Cap 100mg","code_information":[{"code":"CP17744631829737335","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268028115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Firvanq      Sol 25mg/ml","code_information":[{"code":"CP17744631829953484","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628020510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Gnp Mucus Er Tab 1200mg","code_information":[{"code":"CP17744631830056087","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122068374","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Guaifenesin  Tab 1200mg","code_information":[{"code":"CP17744631830065277","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830113109","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598072101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Hypo Needle  Mis 23gx1\"","code_information":[{"code":"CP17744631830121009","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305193","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ibgard       Cap","code_information":[{"code":"CP17744631830127377","type":"CDM"},{"code":"250","type":"RC"},{"code":"69266000012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Icosapent    Cap 1gm","code_information":[{"code":"CP17744631830135658","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710159207","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Iv Introcan Cath 24g-3/4","code_information":[{"code":"CP17744631830173970","type":"CDM"},{"code":"250","type":"RC"},{"code":"42535","type":"CPT","modifier":"23"}],"standard_charges":[{"setting":"outpatient","modifier_code":["23"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lamotrigine  Tab 25mg","code_information":[{"code":"CP17744631830215014","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862022701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine 25mg Tabs","code_information":[{"code":"CP17744631830217053","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097014807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Lamotrigine 25mg Tabs","code_information":[{"code":"CP17744631830215004","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746024505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Leucovor Ca  Tab 5mg","code_information":[{"code":"CP17744631830296833","type":"CDM"},{"code":"250","type":"RC"},{"code":"54449","type":"CPT","modifier":"625"}],"standard_charges":[{"setting":"outpatient","modifier_code":["625"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Loratadine-d Tab 10-240mg","code_information":[{"code":"CP17744631830368878","type":"CDM"},{"code":"250","type":"RC"},{"code":"90458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Methylpred   Tab 8mg","code_information":[{"code":"CP17744631830456427","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762004901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Metolazone   Tab 2.5mg","code_information":[{"code":"CP17744631830455676","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332053231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metolazone   Tab 5mg","code_information":[{"code":"CP17744631830455557","type":"CDM"},{"code":"250","type":"RC"},{"code":"37861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mucinex      Tab 1200mg","code_information":[{"code":"CP17744631830516222","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Mucinex      Tab Sinus","code_information":[{"code":"CP17744631830511789","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824020120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mucinex Cold Tab Flu&sore","code_information":[{"code":"CP17744631830515775","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824023721","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mucinex Fast Max","code_information":[{"code":"CP17744631830513630","type":"CDM"},{"code":"250","type":"RC"},{"code":"6382419320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mucus Er-1200mg","code_information":[{"code":"CP17744631830512300","type":"CDM"},{"code":"250","type":"RC"},{"code":"46122068374","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830536275","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224020630","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Omega-3 Acid 1g Caps","code_information":[{"code":"CP17744631830671334","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505317007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Omega-3-acid Cap 1gm","code_information":[{"code":"CP17744631830675349","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505317007","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"GR"}},{"description":"Oxazepam     Cap 10mg","code_information":[{"code":"CP17744631830702199","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pilocarpine  Tab 7.5mg","code_information":[{"code":"CP17744631830776246","type":"CDM"},{"code":"250","type":"RC"},{"code":"22828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Rifampin     Cap 300mg","code_information":[{"code":"CP17744631830893040","type":"CDM"},{"code":"250","type":"RC"},{"code":"90452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Saccharomyce Cap Boulardi","code_information":[{"code":"CP17744631830923325","type":"CDM"},{"code":"250","type":"RC"},{"code":"90472","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Sodium Bicar Tab 650mg","code_information":[{"code":"CP17744631831042517","type":"CDM"},{"code":"250","type":"RC"},{"code":"66553000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Tegretol-xr  Tab 400mg","code_information":[{"code":"CP17744631831105730","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746079101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Timolol Mal  Sol 0.25% Op","code_information":[{"code":"CP17744631831130667","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758080210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Tobramycin   Inj 40mg/ml","code_information":[{"code":"CP17744631831147221","type":"CDM"},{"code":"250","type":"RC"},{"code":"36000024425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Tramadol Hcl Tab 50mg","code_information":[{"code":"CP17744631831169549","type":"CDM"},{"code":"250","type":"RC"},{"code":"93005","type":"CPT","modifier":"805"}],"standard_charges":[{"setting":"outpatient","modifier_code":["805"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Venlafaxine  Cap 37.5 Er","code_information":[{"code":"CP17744631831257426","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714004302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Cap 37.5 Er","code_information":[{"code":"CP17744631831257969","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Cap 37.5 Er","code_information":[{"code":"CP17744631831255828","type":"CDM"},{"code":"250","type":"RC"},{"code":"93738","type":"CPT","modifier":"498"}],"standard_charges":[{"setting":"outpatient","modifier_code":["498"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Cap 37.5 Er","code_information":[{"code":"CP17744631831259383","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862052730","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine Er 37.5mg Caps","code_information":[{"code":"CP17744631831263842","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382003410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Venlafaxine Er 37.5mg Caps","code_information":[{"code":"CP17744631831266287","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382003416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Alclometason Oin 0.05%","code_information":[{"code":"CP17744631828399045","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Amlod/benazp Cap 5-40mg","code_information":[{"code":"CP17744631828482291","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237014501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amlod/benazp Cap 5-40mg","code_information":[{"code":"CP17744631828485153","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862058501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amphet/dextr Tab 12.5mg","code_information":[{"code":"CP17744631828510747","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714080501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Betameth Dip Oin 0.05%","code_information":[{"code":"CP17744631828877440","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578009301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bisacodyl    Sup 10mg","code_information":[{"code":"CP17744631828927922","type":"CDM"},{"code":"250","type":"RC"},{"code":"57470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"But/asa/caff Cap","code_information":[{"code":"CP17744631829041832","type":"CDM"},{"code":"250","type":"RC"},{"code":"59132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ciclopirox   Gel 0.77%","code_information":[{"code":"CP17744631829226999","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Culturelle   Cap Hlth/wel","code_information":[{"code":"CP17744631829432257","type":"CDM"},{"code":"250","type":"RC"},{"code":"49100036404","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Culturelle   Cap Immunity","code_information":[{"code":"CP17744631829433690","type":"CDM"},{"code":"250","type":"RC"},{"code":"49100036374","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cure Ultra Catheter Fml","code_information":[{"code":"CP17744631829435643","type":"CDM"},{"code":"250","type":"RC"},{"code":"10201","type":"CPT","modifier":"91"}],"standard_charges":[{"setting":"outpatient","modifier_code":["91"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dapsone      Tab 25mg","code_information":[{"code":"CP17744631829475169","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954013520","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dexmethylph  Tab 10mg","code_information":[{"code":"CP17744631829570193","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858041001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diazepam     Sol 5mg/5ml","code_information":[{"code":"CP17744631829584080","type":"CDM"},{"code":"250","type":"RC"},{"code":"68094075062","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Diltiazem    Cap 240mg Er","code_information":[{"code":"CP17744631829692228","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742025030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Divalproex   Tab 500mg Er","code_information":[{"code":"CP17744631829712337","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180026102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Divalproex   Tab 500mg Er","code_information":[{"code":"CP17744631829715051","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180026101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Divalproex   Tab 500mg Er","code_information":[{"code":"CP17744631829712022","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862059505","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Divalproex Er 500mg Tabs","code_information":[{"code":"CP17744631829719839","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162075750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Divalproex Er 500mg Tabs","code_information":[{"code":"CP17744631829714203","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862059501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Doxepin Hcl  Cap 50mg","code_information":[{"code":"CP17744631829738496","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756042611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Doxycyc Mono Tab 100mg","code_information":[{"code":"CP17744631829735830","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fish Oil     Cap 1200mg","code_information":[{"code":"CP17744631829950423","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681005500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Fish Oil--caps 1200mg","code_information":[{"code":"CP17744631829959600","type":"CDM"},{"code":"250","type":"RC"},{"code":"80681005500","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830118568","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664076188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830111749","type":"CDM"},{"code":"250","type":"RC"},{"code":"78159","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Irbesar/hctz Tab 300-12.5","code_information":[{"code":"CP17744631830169824","type":"CDM"},{"code":"250","type":"RC"},{"code":"93823","type":"CPT","modifier":"298"}],"standard_charges":[{"setting":"outpatient","modifier_code":["298"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Irbesar/hctz Tab 300-12.5","code_information":[{"code":"CP17744631830163440","type":"CDM"},{"code":"250","type":"RC"},{"code":"54025","type":"CPT","modifier":"522"}],"standard_charges":[{"setting":"outpatient","modifier_code":["522"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Irbesar/hctz Tab 300-12.5","code_information":[{"code":"CP17744631830160986","type":"CDM"},{"code":"250","type":"RC"},{"code":"54025","type":"CPT","modifier":"513"}],"standard_charges":[{"setting":"outpatient","modifier_code":["513"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Labetalol    Tab 100mg","code_information":[{"code":"CP17744631830194232","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382079801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Liothyronine Tab 5mcg","code_information":[{"code":"CP17744631830342422","type":"CDM"},{"code":"250","type":"RC"},{"code":"93217","type":"CPT","modifier":"901"}],"standard_charges":[{"setting":"outpatient","modifier_code":["901"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Lovastatin   Tab 40mg","code_information":[{"code":"CP17744631830379942","type":"CDM"},{"code":"250","type":"RC"},{"code":"93092","type":"CPT","modifier":"810"}],"standard_charges":[{"setting":"outpatient","modifier_code":["810"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Mag Oxide    Tab 400mg","code_information":[{"code":"CP17744631830398921","type":"CDM"},{"code":"250","type":"RC"},{"code":"10006070028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830442704","type":"CDM"},{"code":"250","type":"RC"},{"code":"54455","type":"CPT","modifier":"15"}],"standard_charges":[{"setting":"outpatient","modifier_code":["15"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830443101","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238142301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830446089","type":"CDM"},{"code":"250","type":"RC"},{"code":"55505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830444279","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781048201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Morphine Sul Tab 30mg","code_information":[{"code":"CP17744631830503770","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877067101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Orajel       Gel 10%","code_information":[{"code":"CP17744631830692066","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310043028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Orajel 20%-0.26% Gel","code_information":[{"code":"CP17744631830695750","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310043028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Orajel 2x    Gel","code_information":[{"code":"CP17744631830690654","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310043028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Orajel 2x Toothache & Gum","code_information":[{"code":"CP17744631830695160","type":"CDM"},{"code":"250","type":"RC"},{"code":"31031043028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Orajel 2x Toothache & Gum","code_information":[{"code":"CP17744631830696561","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310043028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Orajel Gel 20-.26%","code_information":[{"code":"CP17744631830695896","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310043028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Orajel Instant Pain Relie","code_information":[{"code":"CP17744631830699687","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310022240","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Orajel-20%-gel","code_information":[{"code":"CP17744631830693300","type":"CDM"},{"code":"250","type":"RC"},{"code":"10310043028","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Pen Needles  Mis 32gx1/4\"","code_information":[{"code":"CP17744631830740137","type":"CDM"},{"code":"250","type":"RC"},{"code":"57515071014","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles 6mm 32g","code_information":[{"code":"CP17744631830745625","type":"CDM"},{"code":"250","type":"RC"},{"code":"8222710147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles Non Safety 6mm 32g","code_information":[{"code":"CP17744631830745977","type":"CDM"},{"code":"250","type":"RC"},{"code":"8222710147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Polymyxin B/ Sol Trimethp","code_information":[{"code":"CP17744631830784413","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208031510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prenatal-u   Cap 106.5-1","code_information":[{"code":"CP17744631830829846","type":"CDM"},{"code":"250","type":"RC"},{"code":"60258017901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1065,"type":"EA"}},{"description":"Ulticare Pen Needl 31g 8mm","code_information":[{"code":"CP17744631831208672","type":"CDM"},{"code":"250","type":"RC"},{"code":"8222142394","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":31,"type":"GR"}},{"description":"Ulticare Pen Needl 32g 4mm","code_information":[{"code":"CP17744631831200142","type":"CDM"},{"code":"250","type":"RC"},{"code":"8222142387","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":32,"type":"GR"}},{"description":"Valproate    Inj 100mg/ml","code_information":[{"code":"CP17744631831224626","type":"CDM"},{"code":"250","type":"RC"},{"code":"63323049405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Valsartan    Tab 40mg","code_information":[{"code":"CP17744631831229176","type":"CDM"},{"code":"250","type":"RC"},{"code":"37858","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Acetamin     Tab 650mg","code_information":[{"code":"CP17744631828198957","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084077725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Acetaminophe Tab 650mg Er","code_information":[{"code":"CP17744631828203982","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084077725","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":650,"type":"ME"}},{"description":"Amitriptylin Tab 50mg","code_information":[{"code":"CP17744631828478999","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367039001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bumetanide   Tab 0.5mg","code_information":[{"code":"CP17744631828962871","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714083101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Buspirone    Tab 15mg","code_information":[{"code":"CP17744631829001338","type":"CDM"},{"code":"250","type":"RC"},{"code":"93100","type":"CPT","modifier":"305"}],"standard_charges":[{"setting":"outpatient","modifier_code":["305"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"But/apap/caf Cap","code_information":[{"code":"CP17744631829039043","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862054201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Candesartan  Tab 8mg","code_information":[{"code":"CP17744631829097016","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884065909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Carbamazepin Tab 400mg Er","code_information":[{"code":"CP17744631829126141","type":"CDM"},{"code":"250","type":"RC"},{"code":"71930007412","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Desonide     Oin 0.05%","code_information":[{"code":"CP17744631829564684","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672128103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Dexmethylph  Tab 10mg","code_information":[{"code":"CP17744631829577281","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664037988","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Divalproex   Tab 500mg Dr","code_information":[{"code":"CP17744631829712004","type":"CDM"},{"code":"250","type":"RC"},{"code":"83271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Ear Cushion","code_information":[{"code":"CP17744631829767269","type":"CDM"},{"code":"250","type":"RC"},{"code":"86215","type":"CPT","modifier":"0"}],"standard_charges":[{"setting":"outpatient","modifier_code":["0"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estroven     Tab Menopaus","code_information":[{"code":"CP17744631829829690","type":"CDM"},{"code":"250","type":"RC"},{"code":"92961004029","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Flecainide   Tab 100mg","code_information":[{"code":"CP17744631829954077","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806081801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluocinonide Gel 0.05%","code_information":[{"code":"CP17744631829976002","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Gel 0.05%","code_information":[{"code":"CP17744631829976675","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781053326","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Gel 0.05%","code_information":[{"code":"CP17744631829976772","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fosinopril   Tab 40mg","code_information":[{"code":"CP17744631829991814","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547038809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Grafco Silvr Mis Nit Appl","code_information":[{"code":"CP17744631830052222","type":"CDM"},{"code":"250","type":"RC"},{"code":"12165010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Haloperidol  Tab 10mg","code_information":[{"code":"CP17744631830062000","type":"CDM"},{"code":"250","type":"RC"},{"code":"37803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Hc Valerate  Cre 0.2%","code_information":[{"code":"CP17744631830076429","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180095402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Hearing Aid Battery","code_information":[{"code":"CP17744631830070367","type":"CDM"},{"code":"250","type":"RC"},{"code":"9629512019","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydrocort Val 0.2% Cream","code_information":[{"code":"CP17744631830117707","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129006","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Icosapent    Cap 0.5gm","code_information":[{"code":"CP17744631830133160","type":"CDM"},{"code":"250","type":"RC"},{"code":"54062","type":"CPT","modifier":"127"}],"standard_charges":[{"setting":"outpatient","modifier_code":["127"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"GR"}},{"description":"Liothyronine Tab 25mcg","code_information":[{"code":"CP17744631830343621","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794001912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Loxapine     Cap 25mg","code_information":[{"code":"CP17744631830388995","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mucus Relief Tab 600mg Er","code_information":[{"code":"CP17744631830511205","type":"CDM"},{"code":"250","type":"RC"},{"code":"90467","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Mycophenolat Cap 250mg","code_information":[{"code":"CP17744631830523667","type":"CDM"},{"code":"250","type":"RC"},{"code":"93733","type":"CPT","modifier":"405"}],"standard_charges":[{"setting":"outpatient","modifier_code":["405"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Mycophenolat Cap 250mg","code_information":[{"code":"CP17744631830529590","type":"CDM"},{"code":"250","type":"RC"},{"code":"54016","type":"CPT","modifier":"325"}],"standard_charges":[{"setting":"outpatient","modifier_code":["325"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Nadolol      Tab 40mg","code_information":[{"code":"CP17744631830538802","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155073101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nadolol      Tab 40mg","code_information":[{"code":"CP17744631830537203","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332040331","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nadolol      Tab 40mg","code_information":[{"code":"CP17744631830539362","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762081101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Naphcon-a    Sol Op","code_information":[{"code":"CP17744631830536555","type":"CDM"},{"code":"250","type":"RC"},{"code":"65008","type":"CPT","modifier":"515"}],"standard_charges":[{"setting":"outpatient","modifier_code":["515"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Norethin Ace Tab 5mg","code_information":[{"code":"CP17744631830575532","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462030450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxycodone    Cap 5mg","code_information":[{"code":"CP17744631830717586","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559016701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxycodone    Cap Hcl 5mg","code_information":[{"code":"CP17744631830712123","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559016701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phenazopyrid Tab 100mg","code_information":[{"code":"CP17744631830754034","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657045001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Phenazopyrid Tab 200mg","code_information":[{"code":"CP17744631830755375","type":"CDM"},{"code":"250","type":"RC"},{"code":"51293081101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Phenazopyrid Tab 200mg","code_information":[{"code":"CP17744631830755858","type":"CDM"},{"code":"250","type":"RC"},{"code":"42192080201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Phenazopyrid Tab 200mg","code_information":[{"code":"CP17744631830752935","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657045101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Prevail Wmn  Mis Sm-med","code_information":[{"code":"CP17744631830825525","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891090024","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Probenecid   Tab 500mg","code_information":[{"code":"CP17744631830836219","type":"CDM"},{"code":"250","type":"RC"},{"code":"59153","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Progesterone Cap 200mg","code_information":[{"code":"CP17744631830834434","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478076710","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Rivastigmine Cap 1.5mg","code_information":[{"code":"CP17744631830905513","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241001103","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Rivastigmine Cap 1.5mg","code_information":[{"code":"CP17744631830905821","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342008909","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Rivastigmine Cap 3mg","code_information":[{"code":"CP17744631830905186","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rivastigmine Cap 3mg","code_information":[{"code":"CP17744631830903275","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241001203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Rivastigmine Cap 4.5mg","code_information":[{"code":"CP17744631830902234","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241001303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Rivastigmine Cap 6mg","code_information":[{"code":"CP17744631830907632","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Rivastigmine Cap 6mg","code_information":[{"code":"CP17744631830907850","type":"CDM"},{"code":"250","type":"RC"},{"code":"72241001403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Thum         Liq","code_information":[{"code":"CP17744631831126118","type":"CDM"},{"code":"250","type":"RC"},{"code":"11169010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Triamcinolon Lot 0.1%","code_information":[{"code":"CP17744631831184991","type":"CDM"},{"code":"250","type":"RC"},{"code":"60432056161","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Valsart/hctz Tab 160-12.5","code_information":[{"code":"CP17744631831226185","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547031209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"EA"}},{"description":"Venlafaxine  Cap 37.5 Er","code_information":[{"code":"CP17744631831259709","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714004301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"EA"}},{"description":"Venlafaxine  Tab 37.5mg","code_information":[{"code":"CP17744631831252003","type":"CDM"},{"code":"250","type":"RC"},{"code":"93914","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Acetic Acid  Sol 2% Otic","code_information":[{"code":"CP17744631828269484","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980042415","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Amantadine   Tab 100mg","code_information":[{"code":"CP17744631828466349","type":"CDM"},{"code":"250","type":"RC"},{"code":"83201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Baclofen     Tab 5mg","code_information":[{"code":"CP17744631828838527","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817031910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bd Pen Needl Mis 29gx12.7","code_information":[{"code":"CP17744631828841271","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290328203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bd Pen Needl Mis 31gx5mm","code_information":[{"code":"CP17744631828847303","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bd Pen Needl Mis 31gx8mm","code_information":[{"code":"CP17744631828846811","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bd Pen Needl Mis 32gx4mm","code_information":[{"code":"CP17744631828843212","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Cimetidine   Tab 400mg","code_information":[{"code":"CP17744631829234055","type":"CDM"},{"code":"250","type":"RC"},{"code":"93820","type":"CPT","modifier":"401"}],"standard_charges":[{"setting":"outpatient","modifier_code":["401"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Clozapine 200mg Tabs","code_information":[{"code":"CP17744631829392686","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862027405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Colesevelam  Tab 625mg","code_information":[{"code":"CP17744631829407461","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462043318","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Colesevelam  Tab 625mg","code_information":[{"code":"CP17744631829403668","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877050651","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Coq-10 400mg","code_information":[{"code":"CP17744631829429092","type":"CDM"},{"code":"250","type":"RC"},{"code":"40093010906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Dexamethason Tab 6mg","code_information":[{"code":"CP17744631829570541","type":"CDM"},{"code":"250","type":"RC"},{"code":"54418","type":"CPT","modifier":"625"}],"standard_charges":[{"setting":"outpatient","modifier_code":["625"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"ME"}},{"description":"Dilt-xr      Cap 240mg","code_information":[{"code":"CP17744631829701214","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505001608","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Fluconazole  Tab 150mg","code_information":[{"code":"CP17744631829969189","type":"CDM"},{"code":"250","type":"RC"},{"code":"51407042612","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Glycopyrrol  Tab 1mg","code_information":[{"code":"CP17744631830058650","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155060601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Glycopyrrol  Tab 2mg","code_information":[{"code":"CP17744631830058786","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884006601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Midodrine    Tab 2.5mg","code_information":[{"code":"CP17744631830487133","type":"CDM"},{"code":"250","type":"RC"},{"code":"90468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Morphine 5mg/0.25ml Syringe","code_information":[{"code":"CP17744631830507286","type":"CDM"},{"code":"250","type":"RC"},{"code":"40680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Morphine Sul Sol 100/5ml","code_information":[{"code":"CP17744631830509874","type":"CDM"},{"code":"250","type":"RC"},{"code":"40680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Morphine Sul-100mg/5ml 15ml","code_information":[{"code":"CP17744631830508568","type":"CDM"},{"code":"250","type":"RC"},{"code":"40680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Morphine Sulf-100mg/5ml (15ml)","code_information":[{"code":"CP17744631830509824","type":"CDM"},{"code":"250","type":"RC"},{"code":"40680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Move Free Ult Cap +Ucii","code_information":[{"code":"CP17744631830513323","type":"CDM"},{"code":"250","type":"RC"},{"code":"2052511841","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Mycophenolat Cap 250mg","code_information":[{"code":"CP17744631830523136","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380072606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Mycophenolat Cap 250mg","code_information":[{"code":"CP17744631830527859","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729009416","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Mycophenolat Cap 250mg","code_information":[{"code":"CP17744631830525367","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729009401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Nadolol      Tab 40mg","code_information":[{"code":"CP17744631830539309","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651025101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nadolol      Tab 40mg","code_information":[{"code":"CP17744631830531927","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097086807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nadolol 40mg Tabs","code_information":[{"code":"CP17744631830533168","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097086807","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Nortriptylin Cap 10mg","code_information":[{"code":"CP17744631830572051","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268060315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycodone    Tab 10mg","code_information":[{"code":"CP17744631830713544","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084096801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pen Needles 31gx3/16","code_information":[{"code":"CP17744631830749597","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles 31gx5/16","code_information":[{"code":"CP17744631830744882","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles Non Safety 32g","code_information":[{"code":"CP17744631830743919","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320122","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles Non Safety31gx3/16","code_information":[{"code":"CP17744631830744533","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320119","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pen Needles Non Safety31gx5/16","code_information":[{"code":"CP17744631830749231","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290320109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenytoin    Inj 50mg/ml","code_information":[{"code":"CP17744631830761288","type":"CDM"},{"code":"250","type":"RC"},{"code":"64104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Prilosec Otc Tab 20mg","code_information":[{"code":"CP17744631830832828","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000035907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Prilosec Otc Tab 20mg","code_information":[{"code":"CP17744631830839293","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000045504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Prilosec Otc Tab 20mg","code_information":[{"code":"CP17744631830837829","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000045904","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Rufinamide   Sus 40mg/ml","code_information":[{"code":"CP17744631830921981","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452022384","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Sotalol Hcl  Tab 160mg","code_information":[{"code":"CP17744631831059913","type":"CDM"},{"code":"250","type":"RC"},{"code":"69584084310","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Systane      Sol","code_information":[{"code":"CP17744631831098561","type":"CDM"},{"code":"250","type":"RC"},{"code":"65042","type":"CPT","modifier":"930"}],"standard_charges":[{"setting":"outpatient","modifier_code":["930"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Thioridazine Tab 100mg","code_information":[{"code":"CP17744631831127307","type":"CDM"},{"code":"250","type":"RC"},{"code":"37806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Thiothixene  Cap 1mg","code_information":[{"code":"CP17744631831124731","type":"CDM"},{"code":"250","type":"RC"},{"code":"37810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Valsart/hctz Tab 80-12.5","code_information":[{"code":"CP17744631831229398","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862054790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Valsart/hctz Tab 80-12.5","code_information":[{"code":"CP17744631831226842","type":"CDM"},{"code":"250","type":"RC"},{"code":"37863","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Valsart/hctz Tab 80-12.5","code_information":[{"code":"CP17744631831226041","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"EA"}},{"description":"Valsartan/hctz 80-12.5mg Tabs","code_information":[{"code":"CP17744631831220865","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342007410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Zyrtec Allgy Cap 10mg","code_information":[{"code":"CP17744631831417862","type":"CDM"},{"code":"250","type":"RC"},{"code":"45020","type":"CPT","modifier":"444"}],"standard_charges":[{"setting":"outpatient","modifier_code":["444"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"47335018788  Carbi Levod Odt","code_information":[{"code":"CP17744631828090815","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Airborne     Tab","code_information":[{"code":"CP17744631828373905","type":"CDM"},{"code":"250","type":"RC"},{"code":"47865010001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alavert Alrg Tab /Sinus","code_information":[{"code":"CP17744631828373218","type":"CDM"},{"code":"250","type":"RC"},{"code":"57326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anasept","code_information":[{"code":"CP17744631828532270","type":"CDM"},{"code":"250","type":"RC"},{"code":"67180050015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Anasept      Gel","code_information":[{"code":"CP17744631828530069","type":"CDM"},{"code":"250","type":"RC"},{"code":"67180050015","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Dro 0.05%","code_information":[{"code":"CP17744631828802807","type":"CDM"},{"code":"250","type":"RC"},{"code":"72266014101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betameth Dip Cre 0.05%","code_information":[{"code":"CP17744631828861839","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672127406","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bumetanide   Inj 0.25/ml","code_information":[{"code":"CP17744631828968564","type":"CDM"},{"code":"250","type":"RC"},{"code":"40914","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Bupropion    Tab 150mg Sr","code_information":[{"code":"CP17744631828984588","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806041360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Captopril    Tab 25mg","code_information":[{"code":"CP17744631829103021","type":"CDM"},{"code":"250","type":"RC"},{"code":"14311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo    Tab 25-100mg","code_information":[{"code":"CP17744631829109005","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo Odt 25-100mg","code_information":[{"code":"CP17744631829117125","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo Tab 25-100mg Odt","code_information":[{"code":"CP17744631829119794","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carbamazepin Cap 200mg Er","code_information":[{"code":"CP17744631829110295","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505280607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Carbamazepine Er 200mg Caps","code_information":[{"code":"CP17744631829129253","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505280607","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Carbidopa/levo Odt 25/100mg","code_information":[{"code":"CP17744631829127094","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clonazep Odt Tab 1mg","code_information":[{"code":"CP17744631829377550","type":"CDM"},{"code":"250","type":"RC"},{"code":"93929","type":"CPT","modifier":"367"}],"standard_charges":[{"setting":"outpatient","modifier_code":["367"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonazep Odt Tab 1mg","code_information":[{"code":"CP17744631829372778","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884030902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Clonazepam  Odt Tab 1mg","code_information":[{"code":"CP17744631829370049","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884030902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Desoximetas  Cre 0.25%","code_information":[{"code":"CP17744631829560582","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802049535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Diclo/misopr Tab 50-0.2mg","code_information":[{"code":"CP17744631829598588","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571013360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Diltiazem    Cap 240mg/24","code_information":[{"code":"CP17744631829691293","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682036990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Enalapril    Tab 10mg","code_information":[{"code":"CP17744631829776669","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672403901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Enalapril 10mg Tabs","code_information":[{"code":"CP17744631829777453","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672403901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Enemeez Mini","code_information":[{"code":"CP17744631829775558","type":"CDM"},{"code":"250","type":"RC"},{"code":"17433987603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enemeez Plus","code_information":[{"code":"CP17744631829772354","type":"CDM"},{"code":"250","type":"RC"},{"code":"17433987703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Enemeez Plus Ene 20-283","code_information":[{"code":"CP17744631829770465","type":"CDM"},{"code":"250","type":"RC"},{"code":"17433987703","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Estroven +   Tab Energy","code_information":[{"code":"CP17744631829821285","type":"CDM"},{"code":"250","type":"RC"},{"code":"92961001947","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"First Pantpr Sus 4mg/ml","code_information":[{"code":"CP17744631829959370","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628002410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"First-pantpr Sus 4mg/ml","code_information":[{"code":"CP17744631829955703","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628002410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Fluphenazine Elx 2.5/5ml","code_information":[{"code":"CP17744631829977855","type":"CDM"},{"code":"250","type":"RC"},{"code":"12106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Gentamicin   Sol 0.3% Op","code_information":[{"code":"CP17744631830029242","type":"CDM"},{"code":"250","type":"RC"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Gentlecath   Mis 12fr/16\"","code_information":[{"code":"CP17744631830031531","type":"CDM"},{"code":"250","type":"RC"},{"code":"68455011151","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Glydo        Gel 2%","code_information":[{"code":"CP17744631830050086","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Glydo (Lidocain) Hcl 2% Urojet","code_information":[{"code":"CP17744631830051121","type":"CDM"},{"code":"250","type":"RC"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hydroxychlor Tab 200mg","code_information":[{"code":"CP17744631830114880","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664076113","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"K-phos       Tab","code_information":[{"code":"CP17744631830194726","type":"CDM"},{"code":"250","type":"RC"},{"code":"48611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"K-phos 500mg Tabs","code_information":[{"code":"CP17744631830197223","type":"CDM"},{"code":"250","type":"RC"},{"code":"48611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"K-phos-500mg-tabs","code_information":[{"code":"CP17744631830192939","type":"CDM"},{"code":"250","type":"RC"},{"code":"48611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Lansoprazole Sus 3mg/ml","code_information":[{"code":"CP17744631830214528","type":"CDM"},{"code":"250","type":"RC"},{"code":"65628008010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Levothyroxin Tab 300mcg","code_information":[{"code":"CP17744631830317927","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180097609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Mexiletine   Cap 200mg","code_information":[{"code":"CP17744631830471269","type":"CDM"},{"code":"250","type":"RC"},{"code":"93874","type":"CPT","modifier":"1"}],"standard_charges":[{"setting":"outpatient","modifier_code":["1"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Mucinex      Tab 1200mg","code_information":[{"code":"CP17744631830515299","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824002346","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"ME"}},{"description":"Mucinex Dm   Tab 30-600er","code_information":[{"code":"CP17744631830514767","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824005632","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"EA"}},{"description":"Omeprazole   Tab 20mg Dr","code_information":[{"code":"CP17744631830688481","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Perphenazine 16mg Tabs","code_information":[{"code":"CP17744631830751345","type":"CDM"},{"code":"250","type":"RC"},{"code":"59141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Perphenazine Tab 16mg","code_information":[{"code":"CP17744631830756734","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155080201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Perphenazine Tab 16mg","code_information":[{"code":"CP17744631830757970","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980029301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Perphenazine Tab 16mg","code_information":[{"code":"CP17744631830757023","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382059401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Perphenazine Tab 16mg","code_information":[{"code":"CP17744631830753222","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Perphenazine Tab 16mg","code_information":[{"code":"CP17744631830752390","type":"CDM"},{"code":"250","type":"RC"},{"code":"59141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Perphenazine Tab 16mg","code_information":[{"code":"CP17744631830756523","type":"CDM"},{"code":"250","type":"RC"},{"code":"52536017001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":16,"type":"ME"}},{"description":"Prochlorper  Tab 10mg","code_information":[{"code":"CP17744631830834364","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710166801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Propranolol  Cap 160mg Er","code_information":[{"code":"CP17744631830840290","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991082001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":160,"type":"ME"}},{"description":"Propranolol  Cap 80mg Er","code_information":[{"code":"CP17744631830848971","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991081801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":80,"type":"ME"}},{"description":"Pull Up'sextra Large","code_information":[{"code":"CP17744631830858859","type":"CDM"},{"code":"250","type":"RC"},{"code":"1010101010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pull Up's Extra Large","code_information":[{"code":"CP17744631830857367","type":"CDM"},{"code":"250","type":"RC"},{"code":"1010101010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rogaine Wmns Aer 5%","code_information":[{"code":"CP17744631830914570","type":"CDM"},{"code":"250","type":"RC"},{"code":"12547078021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Spirono/hctz Tab 25/25","code_information":[{"code":"CP17744631831052723","type":"CDM"},{"code":"250","type":"RC"},{"code":"53489014401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Valsartan    Tab 40mg","code_information":[{"code":"CP17744631831228392","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332004490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Valsartan    Tab 40mg","code_information":[{"code":"CP17744631831225451","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862057030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Valsartan    Tab 40mg","code_information":[{"code":"CP17744631831223961","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746036030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Zyrtec Allgy Tab 10mg","code_information":[{"code":"CP17744631831419463","type":"CDM"},{"code":"250","type":"RC"},{"code":"12547020436","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Acetic Acid  Sol 2% Otic","code_information":[{"code":"CP17744631828266904","type":"CDM"},{"code":"250","type":"RC"},{"code":"60432074116","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Amitriptylin Tab 150mg","code_information":[{"code":"CP17744631828474041","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756020611","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Amitriptylin Tab 150mg","code_information":[{"code":"CP17744631828478248","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729017601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828507879","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571016142","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828507862","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714049401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828508481","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862050220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828501148","type":"CDM"},{"code":"250","type":"RC"},{"code":"78118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828504864","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714029601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828508384","type":"CDM"},{"code":"250","type":"RC"},{"code":"93227","type":"CPT","modifier":"434"}],"standard_charges":[{"setting":"outpatient","modifier_code":["434"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amphet/dextr Tab 30mg","code_information":[{"code":"CP17744631828521881","type":"CDM"},{"code":"250","type":"RC"},{"code":"18508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Artificial   Sol Tears","code_information":[{"code":"CP17744631828753015","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268004315","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azithromycin Sus 200/5ml","code_information":[{"code":"CP17744631828812808","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762312001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Azo D-mannos Cap 500mg","code_information":[{"code":"CP17744631828817899","type":"CDM"},{"code":"250","type":"RC"},{"code":"87651076026","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Betameth Val Aer 0.12%","code_information":[{"code":"CP17744631828877248","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672418803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":12,"type":"EA"}},{"description":"Bupropion    Tab 200mg Sr","code_information":[{"code":"CP17744631828989916","type":"CDM"},{"code":"250","type":"RC"},{"code":"18511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"But/asa/caff Cap","code_information":[{"code":"CP17744631829043796","type":"CDM"},{"code":"250","type":"RC"},{"code":"29033021501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Carboxymethy Sol 0.5%","code_information":[{"code":"CP17744631829120615","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268006815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Clindamycin  Gel 1%","code_information":[{"code":"CP17744631829256780","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Compound W   Pad 40%","code_information":[{"code":"CP17744631829415068","type":"CDM"},{"code":"250","type":"RC"},{"code":"75137059510","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desipramine  Tab 50mg","code_information":[{"code":"CP17744631829568581","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742011401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Desipramine 25mg Tabs","code_information":[{"code":"CP17744631829562439","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238105501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Desonide     Oin 0.05%","code_information":[{"code":"CP17744631829564384","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603016402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Hydroquinone Cre 4%","code_information":[{"code":"CP17744631830117964","type":"CDM"},{"code":"250","type":"RC"},{"code":"69367017401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Ketoconazole Tab 200mg","code_information":[{"code":"CP17744631830192910","type":"CDM"},{"code":"250","type":"RC"},{"code":"35573043330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Ketoconazole Tab 200mg","code_information":[{"code":"CP17744631830193583","type":"CDM"},{"code":"250","type":"RC"},{"code":"35573043302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Loxapine     Cap 50mg","code_information":[{"code":"CP17744631830388044","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Metronidazol Gel 0.75%","code_information":[{"code":"CP17744631830478931","type":"CDM"},{"code":"250","type":"RC"},{"code":"11514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Neosporin Lip Overnt Ther","code_information":[{"code":"CP17744631830554360","type":"CDM"},{"code":"250","type":"RC"},{"code":"31254723871","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nephron Fa   Tab","code_information":[{"code":"CP17744631830551971","type":"CDM"},{"code":"250","type":"RC"},{"code":"59528445601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitrofurantn Cap 100mg","code_information":[{"code":"CP17744631830562718","type":"CDM"},{"code":"250","type":"RC"},{"code":"18501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitrofurantn Cap 100mg","code_information":[{"code":"CP17744631830567112","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781030301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitroglycer  Dis 0.4mg/hr","code_information":[{"code":"CP17744631830569819","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitroglycerin 0.4mg/hr Patch","code_information":[{"code":"CP17744631830563209","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Nitro-time   Cap 6.5mg Cr","code_information":[{"code":"CP17744631830573392","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483022210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":65,"type":"ME"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830647604","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332060660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830643777","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830649347","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180054503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830647141","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Cre","code_information":[{"code":"CP17744631830647537","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462031465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Oin","code_information":[{"code":"CP17744631830644581","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462079965","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Oin","code_information":[{"code":"CP17744631830649358","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922003107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/triam + Zinc 1:1","code_information":[{"code":"CP17744631830652096","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672126303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystatin/triamcinolone Cream","code_information":[{"code":"CP17744631830653660","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462031465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nyst-triam/lido/zinc/calm/myla","code_information":[{"code":"CP17744631830651161","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462031465","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nyst-triam/lido/zinc/calm/myla","code_information":[{"code":"CP17744631830656907","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332060660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Osteo Bi-flx Tab Advanced","code_information":[{"code":"CP17744631830697055","type":"CDM"},{"code":"250","type":"RC"},{"code":"30768003121","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Oxazepam     Cap 10mg","code_information":[{"code":"CP17744631830705120","type":"CDM"},{"code":"250","type":"RC"},{"code":"52817029010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Peppermint   Oil","code_information":[{"code":"CP17744631830750106","type":"CDM"},{"code":"250","type":"RC"},{"code":"39520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prazosin Hcl Cap 2mg","code_information":[{"code":"CP17744631830813438","type":"CDM"},{"code":"250","type":"RC"},{"code":"93406","type":"CPT","modifier":"801"}],"standard_charges":[{"setting":"outpatient","modifier_code":["801"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Prevail Brf  Mis Medium","code_information":[{"code":"CP17744631830820863","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891024624","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ramipril     Cap 5mg","code_information":[{"code":"CP17744631830873856","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237022401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Silver Sulf Crm 1% / Nystatin","code_information":[{"code":"CP17744631831026822","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332060660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tacrolimus   Cap 0.5mg","code_information":[{"code":"CP17744631831094734","type":"CDM"},{"code":"250","type":"RC"},{"code":"37820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831109911","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382082706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831102547","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382082701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831102939","type":"CDM"},{"code":"250","type":"RC"},{"code":"37802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831102994","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651030090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831106810","type":"CDM"},{"code":"250","type":"RC"},{"code":"51862064330","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831107482","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651030030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Tamoxifen    Tab 20mg","code_information":[{"code":"CP17744631831104456","type":"CDM"},{"code":"250","type":"RC"},{"code":"59124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Testosterone Gel Pump 1%","code_information":[{"code":"CP17744631831119769","type":"CDM"},{"code":"250","type":"RC"},{"code":"59129","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Tranquility  Mis 714","code_information":[{"code":"CP17744631831162827","type":"CDM"},{"code":"250","type":"RC"},{"code":"70319003091","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Venlafaxine  Tab 150mg Er","code_information":[{"code":"CP17744631831252965","type":"CDM"},{"code":"250","type":"RC"},{"code":"72865019990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Zaleplon     Cap 10mg","code_information":[{"code":"CP17744631831394264","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300013201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zaleplon     Cap 10mg","code_information":[{"code":"CP17744631831390968","type":"CDM"},{"code":"250","type":"RC"},{"code":"42043021101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Zinc 20%/nyst/triam/lidoc Crm","code_information":[{"code":"CP17744631831394521","type":"CDM"},{"code":"250","type":"RC"},{"code":"21922003107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Tab 400mg","code_information":[{"code":"CP17744631828339877","type":"CDM"},{"code":"250","type":"RC"},{"code":"50268006115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Airborne     Tab Original","code_information":[{"code":"CP17744631828378678","type":"CDM"},{"code":"250","type":"RC"},{"code":"47865096298","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Alendronate  Sol 70/75ml","code_information":[{"code":"CP17744631828407392","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954026410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ML"}},{"description":"Aug Betamet  Cre 0.05%","code_information":[{"code":"CP17744631828797452","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Betameth Dip Aug 0.05% Oint","code_information":[{"code":"CP17744631828865940","type":"CDM"},{"code":"250","type":"RC"},{"code":"16802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Bromocriptin Tab 2.5mg","code_information":[{"code":"CP17744631828956340","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304096201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo 50 Tab /Entacap","code_information":[{"code":"CP17744631829114849","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"EA"}},{"description":"Carb/levo 75 Tab /Entacap","code_information":[{"code":"CP17744631829110176","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Carb/levo/entac 200mg Tabs","code_information":[{"code":"CP17744631829112764","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Carb/levo125 Tab /Entacap","code_information":[{"code":"CP17744631829111181","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679078504","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Carb/levo125 Tab /Entacap","code_information":[{"code":"CP17744631829111327","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"EA"}},{"description":"Carb/levo150 Tab /Entacap","code_information":[{"code":"CP17744631829114588","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Carb/levo150 Tab /Entacap","code_information":[{"code":"CP17744631829110586","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335000588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Carb/levo200 Tab /Entacap","code_information":[{"code":"CP17744631829115361","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571069401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Carb/levo200 Tab /Entacap","code_information":[{"code":"CP17744631829113097","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335000688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Carb/levo200 Tab /Entacap","code_information":[{"code":"CP17744631829114392","type":"CDM"},{"code":"250","type":"RC"},{"code":"64679078704","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"EA"}},{"description":"Carbid/levo/ent 37.5-150-200mg","code_information":[{"code":"CP17744631829125744","type":"CDM"},{"code":"250","type":"RC"},{"code":"78156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":375,"type":"ME"}},{"description":"Carnitor     Tab 330mg","code_information":[{"code":"CP17744631829130616","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571076209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Cartia Xt    Cap 180/24hr","code_information":[{"code":"CP17744631829130590","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037059890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"EA"}},{"description":"Cartia Xt    Cap 180/24hr","code_information":[{"code":"CP17744631829133935","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037059805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"EA"}},{"description":"Cefadroxil   Cap 500mg","code_information":[{"code":"CP17744631829142804","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714038801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Clindamycin  Cap 300mg","code_information":[{"code":"CP17744631829256243","type":"CDM"},{"code":"250","type":"RC"},{"code":"42571025201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Clindamycin  Cap 300mg","code_information":[{"code":"CP17744631829253037","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304069301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Clindamycin 300mg Caps","code_information":[{"code":"CP17744631829256476","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304069301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Clotrim/beta Cre Diprop","code_information":[{"code":"CP17744631829382271","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462029817","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Colesevelam  Tab 625mg","code_information":[{"code":"CP17744631829402879","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834015218","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Colesevelam  Tab 625mg","code_information":[{"code":"CP17744631829406840","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598023018","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":625,"type":"ME"}},{"description":"Cromolyn Sod Sol 4% Op","code_information":[{"code":"CP17744631829433451","type":"CDM"},{"code":"250","type":"RC"},{"code":"17478029111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Culturelle   Cap","code_information":[{"code":"CP17744631829434314","type":"CDM"},{"code":"250","type":"RC"},{"code":"49100040009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Debrox       Sol 6.5% Ot","code_information":[{"code":"CP17744631829547526","type":"CDM"},{"code":"250","type":"RC"},{"code":"42037010479","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":65,"type":"EA"}},{"description":"Dekas Plus   Cap","code_information":[{"code":"CP17744631829558292","type":"CDM"},{"code":"250","type":"RC"},{"code":"68176000011","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desonide     Lot 0.05%","code_information":[{"code":"CP17744631829569867","type":"CDM"},{"code":"250","type":"RC"},{"code":"47208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Desonide     Lot 0.05%","code_information":[{"code":"CP17744631829568672","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672407908","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Diflunisal   Tab 500mg","code_information":[{"code":"CP17744631829600031","type":"CDM"},{"code":"250","type":"RC"},{"code":"14539067306","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Felodipine   Tab 10mg Er","code_information":[{"code":"CP17744631829846680","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237011001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Ferrous Sulf Syp 300/5ml","code_information":[{"code":"CP17744631829864139","type":"CDM"},{"code":"250","type":"RC"},{"code":"12105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Fludrocort   Tab 0.1mg","code_information":[{"code":"CP17744631829962493","type":"CDM"},{"code":"250","type":"RC"},{"code":"11570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fludrocortisone 0.1mg Tabs","code_information":[{"code":"CP17744631829966314","type":"CDM"},{"code":"250","type":"RC"},{"code":"11570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Fluvoxamine  Tab 100mg","code_information":[{"code":"CP17744631829987218","type":"CDM"},{"code":"250","type":"RC"},{"code":"83216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Gentamicin   Cre 0.1%","code_information":[{"code":"CP17744631830029170","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565008530","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Guaifen Dm 1200-60 Tab 12h","code_information":[{"code":"CP17744631830069347","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1200,"type":"EA"}},{"description":"Imiquimod    Cre 5%","code_information":[{"code":"CP17744631830131642","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672414506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Imodium Ms   Tab Relief","code_information":[{"code":"CP17744631830132482","type":"CDM"},{"code":"250","type":"RC"},{"code":"45021","type":"CPT","modifier":"218"}],"standard_charges":[{"setting":"outpatient","modifier_code":["218"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ipratropium  Spr 0.03%","code_information":[{"code":"CP17744631830158204","type":"CDM"},{"code":"250","type":"RC"},{"code":"54004","type":"CPT","modifier":"544"}],"standard_charges":[{"setting":"outpatient","modifier_code":["544"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Irbesar/hctz Tab 150-12.5","code_information":[{"code":"CP17744631830162931","type":"CDM"},{"code":"250","type":"RC"},{"code":"93823","type":"CPT","modifier":"856"}],"standard_charges":[{"setting":"outpatient","modifier_code":["856"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Irbesar/hctz Tab 150-12.5","code_information":[{"code":"CP17744631830169235","type":"CDM"},{"code":"250","type":"RC"},{"code":"54025","type":"CPT","modifier":"422"}],"standard_charges":[{"setting":"outpatient","modifier_code":["422"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Irbesar/hctz Tab 150-12.5","code_information":[{"code":"CP17744631830164549","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342005707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"EA"}},{"description":"Irbesar/hctz Tab 300-12.5","code_information":[{"code":"CP17744631830164068","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332005290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"EA"}},{"description":"Labetalol    Tab 200mg","code_information":[{"code":"CP17744631830205384","type":"CDM"},{"code":"250","type":"RC"},{"code":"71247012701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Leucovor Ca  Tab 5mg","code_information":[{"code":"CP17744631830294836","type":"CDM"},{"code":"250","type":"RC"},{"code":"55504","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Levocarnitin Tab 330mg","code_information":[{"code":"CP17744631830302837","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571076209","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":330,"type":"ME"}},{"description":"Li/zn/ad/ny/ma","code_information":[{"code":"CP17744631830323487","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291039930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Li/zn/ad/ny/ma","code_information":[{"code":"CP17744631830329747","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565012230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocai/clotrimaz/hydroc/zinc","code_information":[{"code":"CP17744631830325911","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925015903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain / Zinc Oxide Crm","code_information":[{"code":"CP17744631830325787","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925015903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocain/zinc Oxi/geri-lanta","code_information":[{"code":"CP17744631830320085","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925015903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lidocaine    Cre 3%","code_information":[{"code":"CP17744631830325237","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925015903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Lidocaine    Cre 4%","code_information":[{"code":"CP17744631830331079","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291039930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Lidocaine    Cre 4%","code_information":[{"code":"CP17744631830335232","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781057073","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Lidocaine    Cre 4%","code_information":[{"code":"CP17744631830339293","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565012230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"EA"}},{"description":"Lidocaine 3% Zinc 40 Lotrisone","code_information":[{"code":"CP17744631830332489","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925015903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Lidocaine3%/adoint/desitin","code_information":[{"code":"CP17744631830342569","type":"CDM"},{"code":"250","type":"RC"},{"code":"13925015903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"EA"}},{"description":"Methylphenid Tab 20mg","code_information":[{"code":"CP17744631830450187","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729048001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Metoprol Suc Tab 200mg Er","code_information":[{"code":"CP17744631830465250","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436016701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Midodrine    Tab 5mg","code_information":[{"code":"CP17744631830484554","type":"CDM"},{"code":"250","type":"RC"},{"code":"70756004911","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Mucus Relief Tab 60-1200","code_information":[{"code":"CP17744631830514273","type":"CDM"},{"code":"250","type":"RC"},{"code":"53612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Mucus Rlf D  Tab 120-1200","code_information":[{"code":"CP17744631830519343","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000060801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"EA"}},{"description":"Nateglinide  Tab 120mg","code_information":[{"code":"CP17744631830541434","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834020601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Oxybutynin   Tab 5mg Er","code_information":[{"code":"CP17744631830701481","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980020901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Oxybutynin Chloride Er Tab 5mg","code_information":[{"code":"CP17744631830705784","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980020901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pfizer Vacc  Inj Covid-19","code_information":[{"code":"CP17744631830759554","type":"CDM"},{"code":"250","type":"RC"},{"code":"59267100001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":19,"type":"EA"}},{"description":"Prednisone   Tab 20mg","code_information":[{"code":"CP17744631830816236","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219170805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Prevail      Mis Per-fit","code_information":[{"code":"CP17744631830827572","type":"CDM"},{"code":"250","type":"RC"},{"code":"90891019004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Probenecid   Tab 500mg","code_information":[{"code":"CP17744631830830067","type":"CDM"},{"code":"250","type":"RC"},{"code":"52713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Propranolol  Cap 120mg Er","code_information":[{"code":"CP17744631830841650","type":"CDM"},{"code":"250","type":"RC"},{"code":"42291052401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Propranolol  Cap 120mg Er","code_information":[{"code":"CP17744631830844520","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559053201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Surgical Paper Tape 1\"","code_information":[{"code":"CP17744631831089911","type":"CDM"},{"code":"250","type":"RC"},{"code":"61247912345","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acebutolol   Cap 400mg","code_information":[{"code":"CP17744631828185673","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746067001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Acyclovir    Tab 800mg","code_information":[{"code":"CP17744631828330428","type":"CDM"},{"code":"250","type":"RC"},{"code":"61442011301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Allrgy D-12  Tab 5-120mg","code_information":[{"code":"CP17744631828429535","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000050403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Amox/k Clav  Tab 500-125","code_information":[{"code":"CP17744631828509717","type":"CDM"},{"code":"250","type":"RC"},{"code":"66685100202","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Amphet/dextr Tab 10mg","code_information":[{"code":"CP17744631828513342","type":"CDM"},{"code":"250","type":"RC"},{"code":"52715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amphet/dextr Tab 30mg","code_information":[{"code":"CP17744631828526555","type":"CDM"},{"code":"250","type":"RC"},{"code":"64850050601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829000249","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888006660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829001614","type":"CDM"},{"code":"250","type":"RC"},{"code":"37811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829003520","type":"CDM"},{"code":"250","type":"RC"},{"code":"93520","type":"CPT","modifier":"5"}],"standard_charges":[{"setting":"outpatient","modifier_code":["5"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829008207","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238111906","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829001193","type":"CDM"},{"code":"250","type":"RC"},{"code":"93520","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829006969","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806008660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829005185","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729028912","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Carbamazepin Tab 200mg","code_information":[{"code":"CP17744631829126596","type":"CDM"},{"code":"250","type":"RC"},{"code":"90461","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Cevimeline   Cap 30mg","code_information":[{"code":"CP17744631829203143","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651042201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Chlorthalid  Tab 50mg","code_information":[{"code":"CP17744631829229709","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598016701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Cholestyram  Pow 4gm Lite","code_information":[{"code":"CP17744631829225354","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224000920","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Cilostazol   Tab 100mg","code_information":[{"code":"CP17744631829226407","type":"CDM"},{"code":"250","type":"RC"},{"code":"93206","type":"CPT","modifier":"406"}],"standard_charges":[{"setting":"outpatient","modifier_code":["406"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Cilostazol 100mg Tabs","code_information":[{"code":"CP17744631829223805","type":"CDM"},{"code":"250","type":"RC"},{"code":"93206","type":"CPT","modifier":"406"}],"standard_charges":[{"setting":"outpatient","modifier_code":["406"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Daptomy/nacl Inj 350/50ml","code_information":[{"code":"CP17744631829484321","type":"CDM"},{"code":"250","type":"RC"},{"code":"33807","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ML"}},{"description":"Effer-k      Tab 20meq","code_information":[{"code":"CP17744631829764744","type":"CDM"},{"code":"250","type":"RC"},{"code":"51801001230","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Effer-k      Tab 20meq","code_information":[{"code":"CP17744631829768797","type":"CDM"},{"code":"250","type":"RC"},{"code":"51801001130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Fluocin Acet Cre 0.01%","code_information":[{"code":"CP17744631829968747","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565003160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluocin Acet Cre 0.025%","code_information":[{"code":"CP17744631829963162","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565002060","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Fluocinolone 0.01% Cream","code_information":[{"code":"CP17744631829977116","type":"CDM"},{"code":"250","type":"RC"},{"code":"52565003160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluphenazine Tab 10mg","code_information":[{"code":"CP17744631829989471","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672423601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Irbesartan   Tab 300mg","code_information":[{"code":"CP17744631830160234","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332004390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Irbesartan   Tab 300mg","code_information":[{"code":"CP17744631830169541","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746044930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Irbesartan   Tab 300mg","code_information":[{"code":"CP17744631830161737","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547037603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Irbesartan   Tab 300mg","code_information":[{"code":"CP17744631830161929","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342004910","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Irbesartan   Tab 300mg","code_information":[{"code":"CP17744631830169232","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722073130","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Irbesartan   Tab 300mg","code_information":[{"code":"CP17744631830168084","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746044990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Irbesartan 300mg Tabs","code_information":[{"code":"CP17744631830161827","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547037603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Iv Extension Set 7","code_information":[{"code":"CP17744631830175696","type":"CDM"},{"code":"250","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Loxapine     Cap 50mg","code_information":[{"code":"CP17744631830386795","type":"CDM"},{"code":"250","type":"RC"},{"code":"64850089301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Metolazone   Tab 2.5mg","code_information":[{"code":"CP17744631830453874","type":"CDM"},{"code":"250","type":"RC"},{"code":"37861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metoprol Suc Tab 100mg Er","code_information":[{"code":"CP17744631830461084","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834029205","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Morphine Sul Sol 100/5ml","code_information":[{"code":"CP17744631830502536","type":"CDM"},{"code":"250","type":"RC"},{"code":"40680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Mvw Complete Cap D5000","code_information":[{"code":"CP17744631830524455","type":"CDM"},{"code":"250","type":"RC"},{"code":"58204000409","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Nifedipine   Tab 60mg Er","code_information":[{"code":"CP17744631830563003","type":"CDM"},{"code":"250","type":"RC"},{"code":"24979001001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Omeprazole   Tab 20mg","code_information":[{"code":"CP17744631830682575","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802088855","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Osteo Bi-flx Tab 5-loxin","code_information":[{"code":"CP17744631830693182","type":"CDM"},{"code":"250","type":"RC"},{"code":"30768033049","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Oxaprozin    Tab 600mg","code_information":[{"code":"CP17744631830701319","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111017001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Perindopril  Tab 2mg","code_information":[{"code":"CP17744631830756613","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862028601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Perphenazine Tab 4mg","code_information":[{"code":"CP17744631830750208","type":"CDM"},{"code":"250","type":"RC"},{"code":"37853","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Repaglinide  Tab 0.5mg","code_information":[{"code":"CP17744631830887859","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Repaglinide  Tab 1mg","code_information":[{"code":"CP17744631830881813","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664074588","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Repaglinide  Tab 2mg","code_information":[{"code":"CP17744631830895977","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862067201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Repaglinide  Tab 2mg","code_information":[{"code":"CP17744631830891030","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237015901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Theophylline Tab 400mg Er","code_information":[{"code":"CP17744631831124519","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462038001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Tramadol Hcl Tab 100mg Er","code_information":[{"code":"CP17744631831167732","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335085983","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Triazolam    Tab 0.25mg","code_information":[{"code":"CP17744631831182824","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742064601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Trifluoperaz Tab 1mg","code_information":[{"code":"CP17744631831182351","type":"CDM"},{"code":"250","type":"RC"},{"code":"78180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Trifluoperaz Tab 1mg","code_information":[{"code":"CP17744631831187928","type":"CDM"},{"code":"250","type":"RC"},{"code":"37824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"True Metrix  Tes Glucose","code_information":[{"code":"CP17744631831199873","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151146001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Uro-pain     Tab 99.5mg","code_information":[{"code":"CP17744631831219384","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237033042","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":995,"type":"ME"}},{"description":"Uro-pain     Tab 99.5mg","code_information":[{"code":"CP17744631831210994","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237033021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":995,"type":"ME"}},{"description":"Zaleplon     Cap 5mg","code_information":[{"code":"CP17744631831392822","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300013101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zaleplon     Cap 5mg","code_information":[{"code":"CP17744631831391116","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237023901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zaleplon     Cap 5mg","code_information":[{"code":"CP17744631831394405","type":"CDM"},{"code":"250","type":"RC"},{"code":"42043021001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Zegerid Otc","code_information":[{"code":"CP17744631831396895","type":"CDM"},{"code":"250","type":"RC"},{"code":"86000841791","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"30ml Syringe Mis Luer-lok","code_information":[{"code":"CP17744631828071445","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290302832","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ML"}},{"description":"Allopurinol  Tab 300mg","code_information":[{"code":"CP17744631828423305","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135051790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Amitriptylin Tab 25mg","code_information":[{"code":"CP17744631828473375","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687043301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Amphet/dextr Tab 30mg","code_information":[{"code":"CP17744631828518048","type":"CDM"},{"code":"250","type":"RC"},{"code":"18520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Betameth Val Cre 0.1%","code_information":[{"code":"CP17744631828873336","type":"CDM"},{"code":"250","type":"RC"},{"code":"16800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bisoprl/hctz Tab 10/6.25","code_information":[{"code":"CP17744631828936530","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300018901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Bisoprl/hctz Tab 2.5/6.25","code_information":[{"code":"CP17744631828936336","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300018701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Bisoprl/hctz Tab 5-6.25mg","code_information":[{"code":"CP17744631828937954","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300018801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bupropion    Tab 200mg Sr","code_information":[{"code":"CP17744631828986300","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547029010","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829005802","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382018314","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829005648","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300024716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829006952","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651039360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Carisoprodol Tab 350mg","code_information":[{"code":"CP17744631829130868","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228010901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Carisoprodol Tab 350mg","code_information":[{"code":"CP17744631829131407","type":"CDM"},{"code":"250","type":"RC"},{"code":"69584011110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":350,"type":"ME"}},{"description":"Cefadroxil   Cap 500mg","code_information":[{"code":"CP17744631829143791","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180018001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cefadroxil   Cap 500mg","code_information":[{"code":"CP17744631829145331","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237009601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Cimetidine   Tab 300mg","code_information":[{"code":"CP17744631829239834","type":"CDM"},{"code":"250","type":"RC"},{"code":"37803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Clenpiq      Sol","code_information":[{"code":"CP17744631829253255","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566680001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dextroamphet Tab 10mg","code_information":[{"code":"CP17744631829588036","type":"CDM"},{"code":"250","type":"RC"},{"code":"11534018901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Diphenhydram Cap 25mg","code_information":[{"code":"CP17744631829700503","type":"CDM"},{"code":"250","type":"RC"},{"code":"69618002401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Diphenhydramine 25mg Caps","code_information":[{"code":"CP17744631829704108","type":"CDM"},{"code":"250","type":"RC"},{"code":"69618002401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Docusate Sod Liq 50mg/5ml","code_information":[{"code":"CP17744631829715088","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Doxepin Hcl  Cap 10mg","code_information":[{"code":"CP17744631829736886","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714013201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Erythromycin Gel 2%","code_information":[{"code":"CP17744631829803264","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802096696","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Famotidine   Sus 40mg/5ml","code_information":[{"code":"CP17744631829847741","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954031610","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Flecainide   Tab 100mg","code_information":[{"code":"CP17744631829952057","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862062201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Flecainide   Tab 100mg","code_information":[{"code":"CP17744631829953721","type":"CDM"},{"code":"250","type":"RC"},{"code":"54001","type":"CPT","modifier":"125"}],"standard_charges":[{"setting":"outpatient","modifier_code":["125"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Fluconazole  Sus 40mg/ml","code_information":[{"code":"CP17744631829968547","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762503001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Guanfacine   Tab 2mg","code_information":[{"code":"CP17744631830060711","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300045901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Hc Valerate  Cre 0.2%","code_information":[{"code":"CP17744631830070001","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180095403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Hc Valerate  Cre 0.2%","code_information":[{"code":"CP17744631830076093","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672129003","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Heather      Tab 0.35mg","code_information":[{"code":"CP17744631830076168","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462030329","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":35,"type":"ME"}},{"description":"Hyd Pol/cpm  Sus 10-8/5ml","code_information":[{"code":"CP17744631830092621","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808008603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Hydrocod/ibu Tab 7.5-200","code_information":[{"code":"CP17744631830109337","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746014501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"EA"}},{"description":"Hydrocort    Lot 2.5%","code_information":[{"code":"CP17744631830101138","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629252901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Hydromorphon Tab 8mg","code_information":[{"code":"CP17744631830110032","type":"CDM"},{"code":"250","type":"RC"},{"code":"40632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Klor-con M20 Tab 20meq Er","code_information":[{"code":"CP17744631830199835","type":"CDM"},{"code":"250","type":"RC"},{"code":"24553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Liothyronine 5mcg Tabs","code_information":[{"code":"CP17744631830341117","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794001812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Liothyronine Tab 25mcg","code_information":[{"code":"CP17744631830345529","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714016701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Liothyronine Tab 50mcg","code_information":[{"code":"CP17744631830344123","type":"CDM"},{"code":"250","type":"RC"},{"code":"62756059188","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Liothyronine Tab 5mcg","code_information":[{"code":"CP17744631830341038","type":"CDM"},{"code":"250","type":"RC"},{"code":"42794001812","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Methadone    Con 10mg/ml","code_information":[{"code":"CP17744631830447153","type":"CDM"},{"code":"250","type":"RC"},{"code":"52719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mirtazapine  Tab 45mg","code_information":[{"code":"CP17744631830496604","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001005","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":45,"type":"ME"}},{"description":"Mucinex D    Tab 60-600mg","code_information":[{"code":"CP17744631830516569","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824005736","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Naproxen Sod Tab 550mg","code_information":[{"code":"CP17744631830542347","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862051601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Naproxen Sod Tab 550mg","code_information":[{"code":"CP17744631830540913","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228043305","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Naproxen Sod Tab 550mg","code_information":[{"code":"CP17744631830541398","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228043301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":550,"type":"ME"}},{"description":"Nitroglycer  Dis 0.2mg/hr","code_information":[{"code":"CP17744631830561965","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Nitroglycerin 0.2mg/hr Patch","code_information":[{"code":"CP17744631830560419","type":"CDM"},{"code":"250","type":"RC"},{"code":"37891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830718260","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380026301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830714902","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702000950","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830712294","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702000901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830711315","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806000801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830715088","type":"CDM"},{"code":"250","type":"RC"},{"code":"71335141401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830714363","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107005701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830712701","type":"CDM"},{"code":"250","type":"RC"},{"code":"40685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830711186","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162005110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxycodone    Tab 30mg","code_information":[{"code":"CP17744631830714526","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162005150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Oxymorphone  Tab Hcl 5mg","code_information":[{"code":"CP17744631830720294","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722092901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Phenazopyrid Tab 200mg","code_information":[{"code":"CP17744631830758879","type":"CDM"},{"code":"250","type":"RC"},{"code":"71186000425","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Pot Chloride Cap 10meq Er","code_information":[{"code":"CP17744631830791324","type":"CDM"},{"code":"250","type":"RC"},{"code":"62037056001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pyridostigmi Sol 60mg/5ml","code_information":[{"code":"CP17744631830855420","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238173102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Quetiapine   Tab 150mg Er","code_information":[{"code":"CP17744631830867388","type":"CDM"},{"code":"250","type":"RC"},{"code":"90468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Selenium Sul 2.25% Shampoo","code_information":[{"code":"CP17744631830991311","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657047806","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":225,"type":"EA"}},{"description":"Senna        Syp 8.8/5ml","code_information":[{"code":"CP17744631831000398","type":"CDM"},{"code":"250","type":"RC"},{"code":"58657051808","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Thiothixene  Cap 1mg","code_information":[{"code":"CP17744631831120738","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954001410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tranylcyprom Tab 10mg","code_information":[{"code":"CP17744631831163725","type":"CDM"},{"code":"250","type":"RC"},{"code":"64380017601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"7\" Extension Set M/f","code_information":[{"code":"CP17744631828096604","type":"CDM"},{"code":"250","type":"RC"},{"code":"1108424721","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Acyclovir    Tab 800mg","code_information":[{"code":"CP17744631828330539","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722077805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":800,"type":"ME"}},{"description":"Alavert D-12 Tab 5-120mg","code_information":[{"code":"CP17744631828377686","type":"CDM"},{"code":"250","type":"RC"},{"code":"50024042902","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Alprazolam   Tab 2mg Er","code_information":[{"code":"CP17744631828454642","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862045660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Anbesol Max  Gel 20%","code_information":[{"code":"CP17744631828533827","type":"CDM"},{"code":"250","type":"RC"},{"code":"50024043203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Avo Cream    Emu","code_information":[{"code":"CP17744631828809990","type":"CDM"},{"code":"250","type":"RC"},{"code":"13811056545","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Spr 0.1%","code_information":[{"code":"CP17744631828805314","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877047750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Spr 0.1%","code_information":[{"code":"CP17744631828800697","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991081403","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Azelastine   Spr 0.1%","code_information":[{"code":"CP17744631828801681","type":"CDM"},{"code":"250","type":"RC"},{"code":"54029","type":"CPT","modifier":"399"}],"standard_charges":[{"setting":"outpatient","modifier_code":["399"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Betameth Dip Cre 0.05%","code_information":[{"code":"CP17744631828862595","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Campho-pheni Gel 10.8-4.7","code_information":[{"code":"CP17744631829095850","type":"CDM"},{"code":"250","type":"RC"},{"code":"54995000700","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":108,"type":"EA"}},{"description":"Carbamazepin Cap 300mg Er","code_information":[{"code":"CP17744631829113535","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505280707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Cetirizine/pse 5/120mg Tabs","code_information":[{"code":"CP17744631829209214","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011041101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cetirizine-pse Er 5-120 Mg Tab","code_information":[{"code":"CP17744631829204671","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011005501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Chlordiazep  Cap 25mg","code_information":[{"code":"CP17744631829215688","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079014120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Ciclopirox   Gel 0.77%","code_information":[{"code":"CP17744631829226908","type":"CDM"},{"code":"250","type":"RC"},{"code":"57420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Cyclopentol  Sol 1% Op","code_information":[{"code":"CP17744631829441215","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208073506","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dapsone      Tab 100mg","code_information":[{"code":"CP17744631829476227","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980056603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Dipyridamole Tab 25mg","code_information":[{"code":"CP17744631829709301","type":"CDM"},{"code":"250","type":"RC"},{"code":"64980013301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Doxepin Hcl  Cap 25mg","code_information":[{"code":"CP17744631829732878","type":"CDM"},{"code":"250","type":"RC"},{"code":"37831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Esomepra Mag Cap 20mg Dr","code_information":[{"code":"CP17744631829813829","type":"CDM"},{"code":"250","type":"RC"},{"code":"18603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Extension Set W/ultrasite","code_information":[{"code":"CP17744631829838413","type":"CDM"},{"code":"250","type":"RC"},{"code":"4046964185","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Famotidine   Sus 40mg/5ml","code_information":[{"code":"CP17744631829843698","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238209004","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Sus 40mg/5ml","code_information":[{"code":"CP17744631829849207","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603017101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Sus 40mg/5ml","code_information":[{"code":"CP17744631829847882","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382044405","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Sus 40mg/5ml","code_information":[{"code":"CP17744631829849601","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877077589","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Sus 40mg/5ml","code_information":[{"code":"CP17744631829840339","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714024401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Sus 40mg/5ml","code_information":[{"code":"CP17744631829848725","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180015001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Freestyle    Tes Prec Neo","code_information":[{"code":"CP17744631830002321","type":"CDM"},{"code":"250","type":"RC"},{"code":"57599157701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Guanfacine   Tab 1mg","code_information":[{"code":"CP17744631830063025","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746071101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Hydrogel     Gel","code_information":[{"code":"CP17744631830119431","type":"CDM"},{"code":"250","type":"RC"},{"code":"38779229805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Iv Extension Set 7\"","code_information":[{"code":"CP17744631830172360","type":"CDM"},{"code":"250","type":"RC"},{"code":"1108424721","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"K-phos       Tab","code_information":[{"code":"CP17744631830194974","type":"CDM"},{"code":"250","type":"RC"},{"code":"48611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"K-phos 500mg Tabs","code_information":[{"code":"CP17744631830199371","type":"CDM"},{"code":"250","type":"RC"},{"code":"48611","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830305555","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722053712","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830300755","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180011316","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830305737","type":"CDM"},{"code":"250","type":"RC"},{"code":"43547022215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830308604","type":"CDM"},{"code":"250","type":"RC"},{"code":"51079082120","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830300652","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722053705","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830306261","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180011302","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830308608","type":"CDM"},{"code":"250","type":"RC"},{"code":"27808026402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Methotrexate 2.5mg Tabs","code_information":[{"code":"CP17744631830449217","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382077501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830447913","type":"CDM"},{"code":"250","type":"RC"},{"code":"54455","type":"CPT","modifier":"25"}],"standard_charges":[{"setting":"outpatient","modifier_code":["25"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830441939","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335023583","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830448726","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382077501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Methotrexate Tab 2.5mg","code_information":[{"code":"CP17744631830445662","type":"CDM"},{"code":"250","type":"RC"},{"code":"55505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Mirtazapine  Tab 7.5mg","code_information":[{"code":"CP17744631830497105","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664051083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Mirtazapine 7.5mg Tabs","code_information":[{"code":"CP17744631830493934","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664051083","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ME"}},{"description":"Morphine Sul Tab 15mg Er","code_information":[{"code":"CP17744631830509360","type":"CDM"},{"code":"250","type":"RC"},{"code":"40683","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Nitrofur Mac Cap 100mg","code_information":[{"code":"CP17744631830560487","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664023388","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nutrisource  Pak Fiber","code_information":[{"code":"CP17744631830647498","type":"CDM"},{"code":"250","type":"RC"},{"code":"43900097647","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nutrisource  Pak Fiber","code_information":[{"code":"CP17744631830645488","type":"CDM"},{"code":"250","type":"RC"},{"code":"43900097648","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nystat/triam Oin","code_information":[{"code":"CP17744631830644256","type":"CDM"},{"code":"250","type":"RC"},{"code":"72578008801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Olopatadine  Spr 0.6%","code_information":[{"code":"CP17744631830670392","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802010401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":6,"type":"EA"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830718815","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722095101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830716903","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781023063","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830718250","type":"CDM"},{"code":"250","type":"RC"},{"code":"40605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830715137","type":"CDM"},{"code":"250","type":"RC"},{"code":"40605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830717190","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702018750","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830713762","type":"CDM"},{"code":"250","type":"RC"},{"code":"10702018701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Phenelzine   Tab 15mg","code_information":[{"code":"CP17744631830753538","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762011901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Prevail Extra Absorb","code_information":[{"code":"CP17744631830828042","type":"CDM"},{"code":"250","type":"RC"},{"code":"9089150001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Pull Up'slarge","code_information":[{"code":"CP17744631830856433","type":"CDM"},{"code":"250","type":"RC"},{"code":"12518151891","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Rifampin     Cap 300mg","code_information":[{"code":"CP17744631830893892","type":"CDM"},{"code":"250","type":"RC"},{"code":"61748001830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Selegiline   Cap 5mg","code_information":[{"code":"CP17744631830992734","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505005501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Selegiline 5mg Caps","code_information":[{"code":"CP17744631830992362","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505005501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Spirono/hctz Tab 25/25","code_information":[{"code":"CP17744631831053136","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629107101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Spirono/hctz Tab 25/25","code_information":[{"code":"CP17744631831050174","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629107102","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Theophylline Tab 300mg Er","code_information":[{"code":"CP17744631831127029","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315022601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Visine Tired Dro Eye Rlf","code_information":[{"code":"CP17744631831271522","type":"CDM"},{"code":"250","type":"RC"},{"code":"12547049309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Xyzal        Tab 5mg","code_information":[{"code":"CP17744631831389242","type":"CDM"},{"code":"250","type":"RC"},{"code":"41167351001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"1ml Tb Syrng Mis 25gx1\"","code_information":[{"code":"CP17744631828070064","type":"CDM"},{"code":"250","type":"RC"},{"code":"8222251107","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"1ml Tb Syrng Mis 25gx1\"","code_information":[{"code":"CP17744631828073269","type":"CDM"},{"code":"250","type":"RC"},{"code":"57515025110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"1ml Tb Syrng Mis 27gx1/2\"","code_information":[{"code":"CP17744631828071957","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305945","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Amantadine   Cap 100mg","code_information":[{"code":"CP17744631828458693","type":"CDM"},{"code":"250","type":"RC"},{"code":"69452014220","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Amitriptylin Tab 150mg","code_information":[{"code":"CP17744631828478211","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714026201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Amitriptylin Tab 150mg","code_information":[{"code":"CP17744631828475285","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714045101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Amphet/dextr Tab 15mg","code_information":[{"code":"CP17744631828511459","type":"CDM"},{"code":"250","type":"RC"},{"code":"42806034301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Amphet/dextr Tab 5mg","code_information":[{"code":"CP17744631828526199","type":"CDM"},{"code":"250","type":"RC"},{"code":"18520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Boric Acid   Sup 600mg","code_information":[{"code":"CP17744631828942230","type":"CDM"},{"code":"250","type":"RC"},{"code":"87651076030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Buspirone    Tab 30mg","code_information":[{"code":"CP17744631829007441","type":"CDM"},{"code":"250","type":"RC"},{"code":"63629241401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Calc Acetate Tab 667mg","code_information":[{"code":"CP17744631829067395","type":"CDM"},{"code":"250","type":"RC"},{"code":"71321080320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":667,"type":"ME"}},{"description":"Calcium 667mg Tabs","code_information":[{"code":"CP17744631829076215","type":"CDM"},{"code":"250","type":"RC"},{"code":"71321080320","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":667,"type":"ME"}},{"description":"Carbamazepin Tab 100mg Er","code_information":[{"code":"CP17744631829111038","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714006301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Carbamazepin Tab 100mger","code_information":[{"code":"CP17744631829118268","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714006301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Cetiriz/pse  Tab 5-120mg","code_information":[{"code":"CP17744631829209273","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802014753","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Cevimeline   Cap 30mg","code_information":[{"code":"CP17744631829209345","type":"CDM"},{"code":"250","type":"RC"},{"code":"63304047901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ciclopirox   Gel 0.77%","code_information":[{"code":"CP17744631829227813","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462045535","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":77,"type":"EA"}},{"description":"Clenpiq      Sol","code_information":[{"code":"CP17744631829254918","type":"CDM"},{"code":"250","type":"RC"},{"code":"55566670001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clozapine    Tab 25mg","code_information":[{"code":"CP17744631829392771","type":"CDM"},{"code":"250","type":"RC"},{"code":"16729014101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Cold & Hot 5% Patch","code_information":[{"code":"CP17744631829401279","type":"CDM"},{"code":"250","type":"RC"},{"code":"84603600125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cold & Hot 5% Sm Patch","code_information":[{"code":"CP17744631829408158","type":"CDM"},{"code":"250","type":"RC"},{"code":"84603600125","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Coq10 Caps","code_information":[{"code":"CP17744631829422139","type":"CDM"},{"code":"250","type":"RC"},{"code":"84009314027","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Coq10 Caps-400 Mg-caps","code_information":[{"code":"CP17744631829427738","type":"CDM"},{"code":"250","type":"RC"},{"code":"84009314027","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":400,"type":"ME"}},{"description":"Desmopressin Tab 0.1mg","code_information":[{"code":"CP17744631829560793","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714088301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Diltiazem    Cap 180mg/24","code_information":[{"code":"CP17744631829699931","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682036890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Diltiazem    Cap 300mg Er","code_information":[{"code":"CP17744631829692963","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742025190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Diltiazem Er 180mg Caps","code_information":[{"code":"CP17744631829696682","type":"CDM"},{"code":"250","type":"RC"},{"code":"68682036890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":180,"type":"ME"}},{"description":"Flutamide    Cap 125mg","code_information":[{"code":"CP17744631829981532","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884075313","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Fluticasone  Oin 0.005%","code_information":[{"code":"CP17744631829987099","type":"CDM"},{"code":"250","type":"RC"},{"code":"71306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Galantamine  Tab 12mg","code_information":[{"code":"CP17744631830016066","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237005160","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":12,"type":"ME"}},{"description":"Gluco/chondr Tab Complex","code_information":[{"code":"CP17744631830042682","type":"CDM"},{"code":"250","type":"RC"},{"code":"79854001118","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Heparin Lock Inj 10unt/ml","code_information":[{"code":"CP17744631830073174","type":"CDM"},{"code":"250","type":"RC"},{"code":"64253022221","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Hydrocil Ins Pow 95%","code_information":[{"code":"CP17744631830090324","type":"CDM"},{"code":"250","type":"RC"},{"code":"38485080857","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lacosamide   Sol 10mg/ml","code_information":[{"code":"CP17744631830205160","type":"CDM"},{"code":"250","type":"RC"},{"code":"70954048810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"L-arginine   Pow","code_information":[{"code":"CP17744631830222373","type":"CDM"},{"code":"250","type":"RC"},{"code":"51552069805","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830303268","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiraceta Tab 500mg","code_information":[{"code":"CP17744631830303109","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiracetam 500mg Tabs","code_information":[{"code":"CP17744631830300935","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Levetiracetam 500mg Tabs","code_information":[{"code":"CP17744631830308173","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714035502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"ME"}},{"description":"Methylpred   Tab 8mg","code_information":[{"code":"CP17744631830453197","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382091711","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Mexiletine   Cap 250mg","code_information":[{"code":"CP17744631830471732","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559082201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Mucinex      Tab 600mg Er","code_information":[{"code":"CP17744631830519522","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824000832","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":600,"type":"ME"}},{"description":"Novotwist    Mis 32gx5mm","code_information":[{"code":"CP17744631830643470","type":"CDM"},{"code":"250","type":"RC"},{"code":"16918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Phenobarb    Tab 16.2mg","code_information":[{"code":"CP17744631830753428","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739019210","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":162,"type":"ME"}},{"description":"Phenobarb    Tab 64.8mg","code_information":[{"code":"CP17744631830763071","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571066701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":648,"type":"ME"}},{"description":"Prednisolone Sol 15mg/5ml","code_information":[{"code":"CP17744631830816572","type":"CDM"},{"code":"250","type":"RC"},{"code":"12108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Safetyglide 1 Ml Syr 27g","code_information":[{"code":"CP17744631830921722","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305945","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Safetyglide 1 Ml Syr 27g X 1/2","code_information":[{"code":"CP17744631830926442","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305945","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Sm Moleskin  Pad Plus","code_information":[{"code":"CP17744631831034182","type":"CDM"},{"code":"250","type":"RC"},{"code":"10939004433","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Syringe Safety 1ml 25gx5/8","code_information":[{"code":"CP17744631831092940","type":"CDM"},{"code":"250","type":"RC"},{"code":"8222251589","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Tizanidine   Cap 4mg","code_information":[{"code":"CP17744631831130006","type":"CDM"},{"code":"250","type":"RC"},{"code":"60505264907","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine   Cap 4mg","code_information":[{"code":"CP17744631831136552","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710111208","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine   Cap 4mg","code_information":[{"code":"CP17744631831133500","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746067134","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine   Cap 4mg","code_information":[{"code":"CP17744631831131997","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742022515","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine   Cap 4mg","code_information":[{"code":"CP17744631831132973","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888000215","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tizanidine   Cap 4mg","code_information":[{"code":"CP17744631831136657","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877061115","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Topiramate   Cap 15mg","code_information":[{"code":"CP17744631831152883","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382000414","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Venelex      Oin","code_information":[{"code":"CP17744631831254801","type":"CDM"},{"code":"250","type":"RC"},{"code":"58980078021","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Zonisamide   Cap 100mg","code_information":[{"code":"CP17744631831417250","type":"CDM"},{"code":"250","type":"RC"},{"code":"60687023001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Alendronate  Sol 70/75ml","code_information":[{"code":"CP17744631828405461","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":75,"type":"ML"}},{"description":"Alendronate 70mg/75ml Soln","code_information":[{"code":"CP17744631828400343","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224030110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":70,"type":"ME"}},{"description":"Alprazolam   Tab 1mg","code_information":[{"code":"CP17744631828442831","type":"CDM"},{"code":"250","type":"RC"},{"code":"22820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Amiodarone   Tab 200mg","code_information":[{"code":"CP17744631828479685","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888003905","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Anbesol Cold Oin Sore","code_information":[{"code":"CP17744631828538548","type":"CDM"},{"code":"250","type":"RC"},{"code":"57302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Bd Eclipse   Mis 1ml/30g","code_information":[{"code":"CP17744631828847168","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305778","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Bethanechol  Tab 50mg","code_information":[{"code":"CP17744631828875193","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746057401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bethanechol  Tab 50mg","code_information":[{"code":"CP17744631828878028","type":"CDM"},{"code":"250","type":"RC"},{"code":"65162057410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Bethanechol  Tab 5mg","code_information":[{"code":"CP17744631828873947","type":"CDM"},{"code":"250","type":"RC"},{"code":"53746057101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Bisoprl/hctz Tab 2.5/6.25","code_information":[{"code":"CP17744631828935383","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300018713","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Bisoprl/hctz Tab 2.5/6.25","code_information":[{"code":"CP17744631828935448","type":"CDM"},{"code":"250","type":"RC"},{"code":"10135074001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Brimonidine  Sol 0.2% Op","code_information":[{"code":"CP17744631828953589","type":"CDM"},{"code":"250","type":"RC"},{"code":"24208041110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Bupropion    Tab 200mg Sr","code_information":[{"code":"CP17744631828987446","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722006801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Bupropion    Tab 200mg Sr","code_information":[{"code":"CP17744631828981954","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436006001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Bupropion    Tab 200mg Sr","code_information":[{"code":"CP17744631828981599","type":"CDM"},{"code":"250","type":"RC"},{"code":"43598075360","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Candesartan  Tab 4mg","code_information":[{"code":"CP17744631829095663","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884065809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829223258","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877029860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Cholestyram  Pow 4gm","code_information":[{"code":"CP17744631829227118","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241013436","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"GR"}},{"description":"Clonazep Odt Tab 0.25mg","code_information":[{"code":"CP17744631829373688","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884030702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clonazepam  Odt Tab 0.25mg","code_information":[{"code":"CP17744631829379930","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884030702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clonazepam 0.25mg Odt","code_information":[{"code":"CP17744631829379628","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884030702","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Clozapine    Tab 100mg","code_information":[{"code":"CP17744631829398469","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862084601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Desipramine  Tab 50mg","code_information":[{"code":"CP17744631829563633","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155058001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Doxepin 25mg Caps","code_information":[{"code":"CP17744631829733358","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238117009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Doxepin Hcl  Cap 150mg","code_information":[{"code":"CP17744631829739216","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884022203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":150,"type":"ME"}},{"description":"Doxepin Hcl  Cap 25mg","code_information":[{"code":"CP17744631829737771","type":"CDM"},{"code":"250","type":"RC"},{"code":"69238117009","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Dr Scholls   Pad Corn","code_information":[{"code":"CP17744631829743299","type":"CDM"},{"code":"250","type":"RC"},{"code":"11017040970","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Fluvoxamine  Tab 25mg","code_information":[{"code":"CP17744631829985525","type":"CDM"},{"code":"250","type":"RC"},{"code":"62559015801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Gentamicin   Cre 0.1%","code_information":[{"code":"CP17744631830022256","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802005635","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Halobetasol  Cre 0.05%","code_information":[{"code":"CP17744631830060378","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802012935","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Haloperidol  Inj 5mg/ml","code_information":[{"code":"CP17744631830069172","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Haloperidol  Inj 5mg/ml","code_information":[{"code":"CP17744631830060871","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Haloperidol 5mg/ml Inj","code_information":[{"code":"CP17744631830079249","type":"CDM"},{"code":"250","type":"RC"},{"code":"14395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Hm Mucus Dm  Tab 60-1200","code_information":[{"code":"CP17744631830084537","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011042301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Hurricaine   Spr 20%","code_information":[{"code":"CP17744631830094484","type":"CDM"},{"code":"250","type":"RC"},{"code":"28306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Hurricaine 20% Spray","code_information":[{"code":"CP17744631830095290","type":"CDM"},{"code":"250","type":"RC"},{"code":"28306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Ketoconaz2% Hydrocort2.5 % Crm","code_information":[{"code":"CP17744631830188627","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714095502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Ketoconazole Cre 2%","code_information":[{"code":"CP17744631830186741","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714095502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"EA"}},{"description":"Levalbuterol Neb 0.63mg","code_information":[{"code":"CP17744631830292610","type":"CDM"},{"code":"250","type":"RC"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":63,"type":"ME"}},{"description":"Liothyronine Tab 25mcg","code_information":[{"code":"CP17744631830342434","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762120701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Los/hctz 100/25 Unavailable","code_information":[{"code":"CP17744631830367714","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180021709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Losartan/hct 100-12.5mg Tab","code_information":[{"code":"CP17744631830377695","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668011790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830376042","type":"CDM"},{"code":"250","type":"RC"},{"code":"93736","type":"CPT","modifier":"998"}],"standard_charges":[{"setting":"outpatient","modifier_code":["998"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830378701","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180021609","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830376601","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237020890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830375861","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746033830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830375957","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862046930","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830373698","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714022402","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-12.5","code_information":[{"code":"CP17744631830378203","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668011790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830372215","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862047030","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830370666","type":"CDM"},{"code":"250","type":"RC"},{"code":"93736","type":"CPT","modifier":"856"}],"standard_charges":[{"setting":"outpatient","modifier_code":["856"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830371910","type":"CDM"},{"code":"250","type":"RC"},{"code":"59746033990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830379635","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862047090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830377526","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180021706","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830375646","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180021709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hct Tab 100-25","code_information":[{"code":"CP17744631830378693","type":"CDM"},{"code":"250","type":"RC"},{"code":"93736","type":"CPT","modifier":"898"}],"standard_charges":[{"setting":"outpatient","modifier_code":["898"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"EA"}},{"description":"Losartan/hctz 100/25mg Tabs","code_information":[{"code":"CP17744631830371682","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180021709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Losartan/hctz 100/25mg Tabs","code_information":[{"code":"CP17744631830377244","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668011810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mederma      Gel","code_information":[{"code":"CP17744631830400675","type":"CDM"},{"code":"250","type":"RC"},{"code":"25903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metoclopram  Inj 5mg/ml","code_information":[{"code":"CP17744631830459684","type":"CDM"},{"code":"250","type":"RC"},{"code":"70345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Midazolam    Inj 10mg/2ml","code_information":[{"code":"CP17744631830485327","type":"CDM"},{"code":"250","type":"RC"},{"code":"64160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Minocycline  Cap 100mg","code_information":[{"code":"CP17744631830484614","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664085385","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline  Cap 100mg","code_information":[{"code":"CP17744631830480962","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862021150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline  Cap 100mg","code_information":[{"code":"CP17744631830485820","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668048450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline  Cap 100mg","code_information":[{"code":"CP17744631830486354","type":"CDM"},{"code":"250","type":"RC"},{"code":"59156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Minocycline  Tab 50mg","code_information":[{"code":"CP17744631830485299","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651033701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Minocycline/nystatin/hydrocort","code_information":[{"code":"CP17744631830483816","type":"CDM"},{"code":"250","type":"RC"},{"code":"13668048450","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Minoxidil    Tab 10mg","code_information":[{"code":"CP17744631830499221","type":"CDM"},{"code":"250","type":"RC"},{"code":"49884025701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mucus Dm Tab 60-1200","code_information":[{"code":"CP17744631830514362","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011042301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"EA"}},{"description":"Nadolol      Tab 20mg","code_information":[{"code":"CP17744631830531628","type":"CDM"},{"code":"250","type":"RC"},{"code":"37800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nadolol      Tab 20mg","code_information":[{"code":"CP17744631830533165","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155073001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nadolol      Tab 20mg","code_information":[{"code":"CP17744631830534747","type":"CDM"},{"code":"250","type":"RC"},{"code":"68382073201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nadolol      Tab 20mg","code_information":[{"code":"CP17744631830535049","type":"CDM"},{"code":"250","type":"RC"},{"code":"69097086707","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Naltrexone   Tab 50mg","code_information":[{"code":"CP17744631830532739","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224020650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Naltrexone Hcl-50mg-tabs","code_information":[{"code":"CP17744631830537793","type":"CDM"},{"code":"250","type":"RC"},{"code":"51224020650","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Nervive Nerve Relief","code_information":[{"code":"CP17744631830557808","type":"CDM"},{"code":"250","type":"RC"},{"code":"3700049580","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Nitrofur Mac Cap 100mg","code_information":[{"code":"CP17744631830565867","type":"CDM"},{"code":"250","type":"RC"},{"code":"47781030801","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitrofur Mac Cap 100mg","code_information":[{"code":"CP17744631830567814","type":"CDM"},{"code":"250","type":"RC"},{"code":"59136","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nitrofur Mac Cap 100mg","code_information":[{"code":"CP17744631830561777","type":"CDM"},{"code":"250","type":"RC"},{"code":"72603018401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Nyquil Liqcap","code_information":[{"code":"CP17744631830645428","type":"CDM"},{"code":"250","type":"RC"},{"code":"37000055716","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Omeprazole   Tab Odt 20mg","code_information":[{"code":"CP17744631830680446","type":"CDM"},{"code":"250","type":"RC"},{"code":"70000038101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Oxybutynin   Tab 15mg Er","code_information":[{"code":"CP17744631830703482","type":"CDM"},{"code":"250","type":"RC"},{"code":"72888003201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Oxycod/apap  Tab 10-325mg","code_information":[{"code":"CP17744631830710657","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107004605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Pen Needles  Mis 30gx3/16","code_information":[{"code":"CP17744631830740483","type":"CDM"},{"code":"250","type":"RC"},{"code":"8470795501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Prazosin 5mg Caps","code_information":[{"code":"CP17744631830802006","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762535001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Prednisone   Tab 1mg","code_information":[{"code":"CP17744631830811583","type":"CDM"},{"code":"250","type":"RC"},{"code":"54474","type":"CPT","modifier":"131"}],"standard_charges":[{"setting":"outpatient","modifier_code":["131"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Safety Insulin Syr 30g-1ml","code_information":[{"code":"CP17744631830927260","type":"CDM"},{"code":"250","type":"RC"},{"code":"8290305778","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ML"}},{"description":"Testosterone Sol 30mg/act","code_information":[{"code":"CP17744631831110804","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802061001","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Tizanidine   Cap 4mg","code_information":[{"code":"CP17744631831131237","type":"CDM"},{"code":"250","type":"RC"},{"code":"75834020815","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":4,"type":"ME"}},{"description":"Tolterodine  Tab 2mg","code_information":[{"code":"CP17744631831145723","type":"CDM"},{"code":"250","type":"RC"},{"code":"93001","type":"CPT","modifier":"805"}],"standard_charges":[{"setting":"outpatient","modifier_code":["805"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Tab 2mg","code_information":[{"code":"CP17744631831145997","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722080660","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Tab 2mg","code_information":[{"code":"CP17744631831150479","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine 2mg Tabs","code_information":[{"code":"CP17744631831154281","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762080002","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine 2mg Tabs","code_information":[{"code":"CP17744631831158372","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Zinc Oxide Oint/ Ketoconaz Cre","code_information":[{"code":"CP17744631831405708","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714095502","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Adek         Chw Plus Zn","code_information":[{"code":"CP17744631828356749","type":"CDM"},{"code":"250","type":"RC"},{"code":"58204000438","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Allergy Rel/ Tab Deconges","code_information":[{"code":"CP17744631828411459","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011007101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Amiodarone   Tab 200mg","code_information":[{"code":"CP17744631828475003","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714084401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Amlod/benazp Cap 10-20mg","code_information":[{"code":"CP17744631828486391","type":"CDM"},{"code":"250","type":"RC"},{"code":"55111034101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/benazp Cap 10-20mg","code_information":[{"code":"CP17744631828481046","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180047201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/benazp Cap 10-20mg","code_information":[{"code":"CP17744631828488170","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862058605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/benazp Cap 10-20mg","code_information":[{"code":"CP17744631828481189","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237014601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlod/benazp Cap 10-20mg","code_information":[{"code":"CP17744631828482090","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862058601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlodipine/benaz 10-20mg Cap","code_information":[{"code":"CP17744631828493199","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237014601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Amlodipine/benaz 10-20mg Caps","code_information":[{"code":"CP17744631828496603","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180047201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Atropine Sul Inj 0.1mg/ml","code_information":[{"code":"CP17744631828793576","type":"CDM"},{"code":"250","type":"RC"},{"code":"40916","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Buprenorphin Sub 8mg","code_information":[{"code":"CP17744631828988374","type":"CDM"},{"code":"250","type":"RC"},{"code":"42858050203","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":8,"type":"ME"}},{"description":"Butal/apap   Tab 50-325mg","code_information":[{"code":"CP17744631829046743","type":"CDM"},{"code":"250","type":"RC"},{"code":"60325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Butenafine   Cre 1%","code_information":[{"code":"CP17744631829049926","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672210008","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Captopr/hctz Tab 25-25mg","code_information":[{"code":"CP17744631829105434","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571082809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo    Tab 10-100mg","code_information":[{"code":"CP17744631829102140","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Carb/levo    Tab 25-250mg","code_information":[{"code":"CP17744631829101520","type":"CDM"},{"code":"250","type":"RC"},{"code":"50228045901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Carb/levo Odt 10/100","code_information":[{"code":"CP17744631829115001","type":"CDM"},{"code":"250","type":"RC"},{"code":"47335018688","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Carboxymethy Sol 0.5%","code_information":[{"code":"CP17744631829123419","type":"CDM"},{"code":"250","type":"RC"},{"code":"53613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Cefpodo Prox Sus 100/5ml","code_information":[{"code":"CP17744631829170040","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040301","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ML"}},{"description":"Clindamycin  Lot 10mg/ml","code_information":[{"code":"CP17744631829254621","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762374401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Clindamycin 1% Lotion","code_information":[{"code":"CP17744631829252338","type":"CDM"},{"code":"250","type":"RC"},{"code":"59762374401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Clozapine    Tab 100mg","code_information":[{"code":"CP17744631829399363","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664034788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Clozapine    Tab 50mg","code_information":[{"code":"CP17744631829397586","type":"CDM"},{"code":"250","type":"RC"},{"code":"37809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Clozapine 100mg Tabs","code_information":[{"code":"CP17744631829393310","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664034788","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"D Mannose","code_information":[{"code":"CP17744631829448457","type":"CDM"},{"code":"250","type":"RC"},{"code":"3373902816","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Dekas        Cap Essentia","code_information":[{"code":"CP17744631829552845","type":"CDM"},{"code":"250","type":"RC"},{"code":"68176000012","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Desoximetas  Cre 0.25%","code_information":[{"code":"CP17744631829563824","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802049537","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Desoximetas  Cre 0.25%","code_information":[{"code":"CP17744631829561977","type":"CDM"},{"code":"250","type":"RC"},{"code":"47204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"EA"}},{"description":"Dextroamphet Tab 10mg","code_information":[{"code":"CP17744631829584056","type":"CDM"},{"code":"250","type":"RC"},{"code":"13107003601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Dialyvite    Tab 5000","code_information":[{"code":"CP17744631829581226","type":"CDM"},{"code":"250","type":"RC"},{"code":"10542001109","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5000,"type":"EA"}},{"description":"Doxycyc Mono Tab 50mg","code_information":[{"code":"CP17744631829747581","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710112101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Doxycycline  Tab 50mg","code_information":[{"code":"CP17744631829745222","type":"CDM"},{"code":"250","type":"RC"},{"code":"70710112101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Duloxetine   Cap 20mg","code_information":[{"code":"CP17744631829752528","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722016860","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Duloxetine   Cap 20mg","code_information":[{"code":"CP17744631829751109","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991074605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Duloxetine   Cap 20mg","code_information":[{"code":"CP17744631829755824","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180029407","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829753274","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180029503","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829753468","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241009809","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829756375","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991074790","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829752244","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877026410","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829759975","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877026430","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine   Cap 30mg","code_information":[{"code":"CP17744631829755123","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241009803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Duloxetine   Cap 60mg","code_information":[{"code":"CP17744631829759628","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Duloxetine   Cap 60mg","code_information":[{"code":"CP17744631829751285","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241009903","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Duloxetine   Cap 60mg","code_information":[{"code":"CP17744631829759398","type":"CDM"},{"code":"250","type":"RC"},{"code":"22828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Duloxetine   Cap 60mg","code_information":[{"code":"CP17744631829756689","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991074890","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Duloxetine   Cap 60mg","code_information":[{"code":"CP17744631829750237","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001990","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Duloxetine   Cap 60mg","code_information":[{"code":"CP17744631829751985","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991074810","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Duloxetine 60mg Caps","code_information":[{"code":"CP17744631829752230","type":"CDM"},{"code":"250","type":"RC"},{"code":"57237001999","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Duloxetine Hcl Cap 20mg","code_information":[{"code":"CP17744631829751913","type":"CDM"},{"code":"250","type":"RC"},{"code":"51991074605","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Escitalopram Tab 5mg","code_information":[{"code":"CP17744631829815155","type":"CDM"},{"code":"250","type":"RC"},{"code":"68180013701","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Famotidine   Tab 40mg","code_information":[{"code":"CP17744631829844329","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332000231","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Tab 40mg","code_information":[{"code":"CP17744631829840386","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332000291","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine   Tab 40mg","code_information":[{"code":"CP17744631829846211","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332000271","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine 40mg Tabs","code_information":[{"code":"CP17744631829840190","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332000291","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Famotidine 40mg Tabs","code_information":[{"code":"CP17744631829848775","type":"CDM"},{"code":"250","type":"RC"},{"code":"62332000271","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Fluocinonide Cre 0.05%","code_information":[{"code":"CP17744631829977321","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672138603","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Fluocinonide Cre 0.05%","code_information":[{"code":"CP17744631829977047","type":"CDM"},{"code":"250","type":"RC"},{"code":"51672138602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"EA"}},{"description":"Foam Toe     Mis Separato","code_information":[{"code":"CP17744631829991820","type":"CDM"},{"code":"250","type":"RC"},{"code":"11917009600","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Furosemide   Inj 10mg/ml","code_information":[{"code":"CP17744631830001010","type":"CDM"},{"code":"250","type":"RC"},{"code":"71288020303","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Genta 480mg/ns 0.9% Irr 1000ml","code_information":[{"code":"CP17744631830028361","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":480,"type":"ME"}},{"description":"Genta/poly 80/500,000","code_information":[{"code":"CP17744631830028766","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentamicin   Inj 40mg/ml","code_information":[{"code":"CP17744631830027650","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Gentamicin 120mg/500ml Sterile","code_information":[{"code":"CP17744631830034264","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":120,"type":"ME"}},{"description":"Gentamicin 240mg/1000ml Ns Irr","code_information":[{"code":"CP17744631830032806","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":240,"type":"ME"}},{"description":"Gentamicin 440mg/100ml Ns","code_information":[{"code":"CP17744631830030248","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":440,"type":"ME"}},{"description":"Gentamicin/ster Watter","code_information":[{"code":"CP17744631830037193","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Gentamicin200/1000ml Ns","code_information":[{"code":"CP17744631830032668","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1000,"type":"ML"}},{"description":"Gentamicin250mg/100ns","code_information":[{"code":"CP17744631830035367","type":"CDM"},{"code":"250","type":"RC"},{"code":"40912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":250,"type":"ME"}},{"description":"Glucose Tabs","code_information":[{"code":"CP17744631830045491","type":"CDM"},{"code":"250","type":"RC"},{"code":"56151161111","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Hyoscyamine  Elx 0.125/5","code_information":[{"code":"CP17744631830124486","type":"CDM"},{"code":"250","type":"RC"},{"code":"62135051147","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Isosorb Mono Tab 30mg Er","code_information":[{"code":"CP17744631830160268","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155051901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Isosorb Mono Tab 30mg Er","code_information":[{"code":"CP17744631830164593","type":"CDM"},{"code":"250","type":"RC"},{"code":"59651053901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Isosorb Mono Tab 30mg Er","code_information":[{"code":"CP17744631830168051","type":"CDM"},{"code":"250","type":"RC"},{"code":"50742017501","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Isosorbide Mono Er 30mg Tabs","code_information":[{"code":"CP17744631830163737","type":"CDM"},{"code":"250","type":"RC"},{"code":"23155051901","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"ME"}},{"description":"Ketorolac    Inj 60mg/2ml","code_information":[{"code":"CP17744631830196551","type":"CDM"},{"code":"250","type":"RC"},{"code":"72611072525","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":60,"type":"ME"}},{"description":"Klor-con M20 Tab 20meq Er","code_information":[{"code":"CP17744631830193259","type":"CDM"},{"code":"250","type":"RC"},{"code":"24553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"EA"}},{"description":"Larin        Tab 1/20","code_information":[{"code":"CP17744631830225674","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714040803","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Lithium Carb Tab 300mg","code_information":[{"code":"CP17744631830350180","type":"CDM"},{"code":"250","type":"RC"},{"code":"54452","type":"CPT","modifier":"725"}],"standard_charges":[{"setting":"outpatient","modifier_code":["725"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":300,"type":"ME"}},{"description":"Loratadine D 10/240mg Tabs","code_information":[{"code":"CP17744631830368992","type":"CDM"},{"code":"250","type":"RC"},{"code":"62011007101","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"ME"}},{"description":"Mederma Adv  Gel Scar","code_information":[{"code":"CP17744631830403640","type":"CDM"},{"code":"250","type":"RC"},{"code":"73302020150","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Metolazone   Tab 2.5mg","code_information":[{"code":"CP17744631830451697","type":"CDM"},{"code":"250","type":"RC"},{"code":"52722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Metolazone 2.5mg Tabs","code_information":[{"code":"CP17744631830466196","type":"CDM"},{"code":"250","type":"RC"},{"code":"52722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Minocycline  Cap 100mg","code_information":[{"code":"CP17744631830481551","type":"CDM"},{"code":"250","type":"RC"},{"code":"65862021105","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":100,"type":"ME"}},{"description":"Mucinex Dm   Tab 30-600er","code_information":[{"code":"CP17744631830517665","type":"CDM"},{"code":"250","type":"RC"},{"code":"63824005634","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":30,"type":"EA"}},{"description":"Nifedipine   Cap 20mg","code_information":[{"code":"CP17744631830567734","type":"CDM"},{"code":"250","type":"RC"},{"code":"69315021201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Nitro-time   Cap 2.5mg Cr","code_information":[{"code":"CP17744631830576795","type":"CDM"},{"code":"250","type":"RC"},{"code":"49483022110","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Omeprazole   Tab 20mg","code_information":[{"code":"CP17744631830687058","type":"CDM"},{"code":"250","type":"RC"},{"code":"45802088830","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":20,"type":"ME"}},{"description":"Pantoprazole Tab 40mg","code_information":[{"code":"CP17744631830733670","type":"CDM"},{"code":"250","type":"RC"},{"code":"68084081309","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":40,"type":"ME"}},{"description":"Pot Chloride Tab 10meq Er","code_information":[{"code":"CP17744631830799059","type":"CDM"},{"code":"250","type":"RC"},{"code":"70436000201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":10,"type":"EA"}},{"description":"Pramipexole  Tab 0.125mg","code_information":[{"code":"CP17744631830808848","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033090","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":125,"type":"ME"}},{"description":"Pramipexole  Tab 0.25mg","code_information":[{"code":"CP17744631830801494","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033190","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Pramipexole  Tab 0.5mg","code_information":[{"code":"CP17744631830802725","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033290","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":5,"type":"ME"}},{"description":"Pramipexole  Tab 1.5mg","code_information":[{"code":"CP17744631830807225","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033490","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":15,"type":"ME"}},{"description":"Pramipexole  Tab 1mg","code_information":[{"code":"CP17744631830807117","type":"CDM"},{"code":"250","type":"RC"},{"code":"68462033390","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Proben/colch Tab 500-0.5","code_information":[{"code":"CP17744631830839626","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571083201","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":500,"type":"EA"}},{"description":"Probiot Prls Cap Womens","code_information":[{"code":"CP17744631830835877","type":"CDM"},{"code":"250","type":"RC"},{"code":"63948010228","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}},{"description":"Quetiapine   Tab 200mg","code_information":[{"code":"CP17744631830862439","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877024601","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":200,"type":"ME"}},{"description":"Quetiapine   Tab 50mg","code_information":[{"code":"CP17744631830866485","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714037602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Quetiapine Fumarate Tab 50mg","code_information":[{"code":"CP17744631830864747","type":"CDM"},{"code":"250","type":"RC"},{"code":"16714037602","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Risperidone  Tab 3mg","code_information":[{"code":"CP17744631830902047","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241000550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Risperidone 3mg Tabs","code_information":[{"code":"CP17744631830903768","type":"CDM"},{"code":"250","type":"RC"},{"code":"27241000550","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":3,"type":"ME"}},{"description":"Thiothixene  Cap 2mg","code_information":[{"code":"CP17744631831129853","type":"CDM"},{"code":"250","type":"RC"},{"code":"60219167401","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":2,"type":"ME"}},{"description":"Tolterodine  Tab 1mg","code_information":[{"code":"CP17744631831141001","type":"CDM"},{"code":"250","type":"RC"},{"code":"29300023916","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tolterodine  Tab 1mg","code_information":[{"code":"CP17744631831145146","type":"CDM"},{"code":"250","type":"RC"},{"code":"93001","type":"CPT","modifier":"6"}],"standard_charges":[{"setting":"outpatient","modifier_code":["6"],"minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tolterodine  Tab 1mg","code_information":[{"code":"CP17744631831144539","type":"CDM"},{"code":"250","type":"RC"},{"code":"33342009709","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tolterodine  Tab 1mg","code_information":[{"code":"CP17744631831143115","type":"CDM"},{"code":"250","type":"RC"},{"code":"16571012606","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tolterodine  Tab 1mg","code_information":[{"code":"CP17744631831144693","type":"CDM"},{"code":"250","type":"RC"},{"code":"31722080560","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"ME"}},{"description":"Tramadol Hcl Tab 50mg","code_information":[{"code":"CP17744631831169618","type":"CDM"},{"code":"250","type":"RC"},{"code":"57664037708","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":50,"type":"ME"}},{"description":"Vancomycin   Sol 25mg/ml","code_information":[{"code":"CP17744631831235868","type":"CDM"},{"code":"250","type":"RC"},{"code":"67877075058","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":25,"type":"ME"}},{"description":"Visine Dry   Sol Eye Rlf","code_information":[{"code":"CP17744631831274500","type":"CDM"},{"code":"250","type":"RC"},{"code":"74300001067","type":"NDC"}],"standard_charges":[{"setting":"both","minimum":1,"maximum":1,"gross_charge":1,"discounted_cash":1,"payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Amerihealth ","plan_name":"HMO","methodology":"percent of total billed charges","standard_charge_dollar":1},{"payer_name":"Independence Keystone Health Plan","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_dollar":1}]}],"drug_information":{"unit":1,"type":"EA"}}],"last_updated_on":"2026-03-31","location_name":["Lawrence Rehabilitation Center"],"hospital_address":["2381 Lawrenceville Road, Lawrence Township, NJ 08648"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Jenelle  Onyenemezu"},"type_2_npi":["1417679481"],"license_information":{"license_number":"21126L","state":"NJ"},"version":"3.0.0"}